Provider Demographics
NPI:1861273278
Name:ISLANDHEALTH.VIP
Entity type:Organization
Organization Name:ISLANDHEALTH.VIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-225-0555
Mailing Address - Street 1:3800 N CENTRAL AVE STE 1010
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1918
Mailing Address - Country:US
Mailing Address - Phone:480-255-0555
Mailing Address - Fax:
Practice Address - Street 1:2439 S KIHEI RD
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-7283
Practice Address - Country:US
Practice Address - Phone:808-336-2611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GO DEHP LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & SportsGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty