Provider Demographics
NPI:1992306864
Name:SFMBA, LLC
Entity type:Organization
Organization Name:SFMBA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:FARMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-268-4330
Mailing Address - Street 1:1378 OWAKA ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-9743
Mailing Address - Country:US
Mailing Address - Phone:808-268-4330
Mailing Address - Fax:
Practice Address - Street 1:1378 OWAKA ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-9743
Practice Address - Country:US
Practice Address - Phone:808-268-4330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty