Basic Information
| Provider Information | |||||||||
| NPI: | 1184254245 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELCHOR | ||||||||
| FirstName: | BRANDI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5661 KEI PL | ||||||||
| Address2: | |||||||||
| City: | KAPAA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967462323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086516265 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3083 AKAHI ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967661102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082459699 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2020 | ||||||||
| LastUpdateDate: | 01/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 106S00000X | HI | Y |
No ID Information.