Healthcare Provider Details

I. General information

NPI: 1154527216
Provider Name (Legal Business Name): RICARDO JOSEPH SAUQUE MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54-182 HANAIMOA ST
HAUULA HI
96717-9615
US

IV. Provider business mailing address

PO BOX 414
HAUULA HI
96717-0414
US

V. Phone/Fax

Practice location:
  • Phone: 808-203-8113
  • Fax:
Mailing address:
  • Phone: 808-203-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: