Provider Demographics
NPI:1184067480
Name:BORRERO, PHYLLIS LAUA'E
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:LAUA'E
Last Name:BORRERO
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 1:3-3122 KUHIO HWY.
Mailing Address - Street 2:SUITE A-15
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766
Mailing Address - Country:US
Mailing Address - Phone:808-246-9102
Mailing Address - Fax:808-246-8609
Practice Address - Street 1:3-3122 KUHIO HWY
Practice Address - Street 2:SUITE A-15
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1147
Practice Address - Country:US
Practice Address - Phone:808-246-9102
Practice Address - Fax:808-246-8609
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst