Basic Information
| Provider Information | |||||||||
| NPI: | 1700927217 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SUBER | ||||||||
| FirstName: | ANGELEA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ND | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOLLANDER | ||||||||
| OtherFirstName: | ANGELEA | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ND | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 65-1235 A OPELO ROAD | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | KAMUELA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088871210 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 65-1235 A OPELO ROAD | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | KAMUELA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8088871210 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 08/03/2010 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175F00000X | 121 | HI | Y | Other Service Providers | Naturopath |
No ID Information.