Healthcare Provider Details

I. General information

NPI: 1508191396
Provider Name (Legal Business Name): ALEXIE ESCONDO RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 10/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 FARRINGTON HWY
KAPOLEI HI
96707-2001
US

IV. Provider business mailing address

575 FARRINGTON HWY
KAPOLEI HI
96707-2001
US

V. Phone/Fax

Practice location:
  • Phone: 808-674-9262
  • Fax: 808-674-8481
Mailing address:
  • Phone: 808-674-9262
  • Fax: 808-674-8481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2440
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: