Healthcare Provider Details

I. General information

NPI: 1013072826
Provider Name (Legal Business Name): PATTIE LUCAS PEREZ RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SAND ISLAND ACCESS RD
HONOLULU HI
96819
US

IV. Provider business mailing address

91-784 LAUNAHELE ST
EWA BEACH HI
96706-4755
US

V. Phone/Fax

Practice location:
  • Phone: 808-842-2930
  • Fax:
Mailing address:
  • Phone: 808-685-5520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3159
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: