Healthcare Provider Details

I. General information

NPI: 1831952555
Provider Name (Legal Business Name): AVIVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 10/31/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-209 MOANALUA RD STE 314
AIEA HI
96701-4042
US

IV. Provider business mailing address

5909 GANNET AVE # B
EWA BEACH HI
96706-3211
US

V. Phone/Fax

Practice location:
  • Phone: 808-797-8721
  • Fax:
Mailing address:
  • Phone: 808-797-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name: MISS MELISSA PULICICCHIO
Title or Position: OWNER
Credential: LICENSED ACUPUNCTURI
Phone: 808-797-8721