Healthcare Provider Details

I. General information

NPI: 1598161218
Provider Name (Legal Business Name): DANIEL GABRIEL NA HIKU RENTERIA A.T.C., L.M.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 11/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 W KAWILI ST
HILO HI
96720-5038
US

IV. Provider business mailing address

PO BOX 188
PEPEEKEO HI
96783-0188
US

V. Phone/Fax

Practice location:
  • Phone: 808-974-4888
  • Fax:
Mailing address:
  • Phone: 808-895-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number83
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number10008
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: