Provider Demographics
NPI:1992501795
Name:BORRETA, JOANNA
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:BORRETA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 MANINO CIR APT 103
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-5200
Mailing Address - Country:US
Mailing Address - Phone:808-633-5007
Mailing Address - Fax:
Practice Address - Street 1:1931 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9761
Practice Address - Country:US
Practice Address - Phone:808-579-8414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-21
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI462-23M405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional