Provider Demographics
NPI:1134850209
Name:MARTUSHOFF, FAEENA S
Entity type:Individual
Prefix:
First Name:FAEENA
Middle Name:S
Last Name:MARTUSHOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ALEA PL
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8703
Mailing Address - Country:US
Mailing Address - Phone:808-500-2886
Mailing Address - Fax:
Practice Address - Street 1:2131 LILIKOI RD
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5046
Practice Address - Country:US
Practice Address - Phone:808-359-4762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-22-216844106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician