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General NPI Number Information
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NPI Number | 1992501795
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Entity Type | Individual
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Provider Name | MS. JOANNA BORRETA
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Gender |
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 1931 BALDWIN AVE
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City | MAKAWAO
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State | HI
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Zip | 96768-9761
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Country | US
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Telephone | 808-579-8414
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Fax |
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Provider Business Mailing Address
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Address Line | 50 MANINO CIR APT 103
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City | KIHEI
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State | HI
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Zip | 96753-5200
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Country | US
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Telephone | 808-633-5007
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number | 462-23M
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License Number State | HI
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