Healthcare Provider Details

I. General information

NPI: 1033817648
Provider Name (Legal Business Name): ASIA LARI ANTOLIN-RICAFRENTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD STE 7400
HONOLULU HI
96813-4902
US

IV. Provider business mailing address

91-1079 KAIKO ST
EWA BEACH HI
96706-6035
US

V. Phone/Fax

Practice location:
  • Phone: 808-354-0910
  • Fax:
Mailing address:
  • Phone: 808-954-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-258778
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: