Healthcare Provider Details

I. General information

NPI: 1518083286
Provider Name (Legal Business Name): MR. RICARDO MOLCZADZKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 BALDWIN AVE
PAIA HI
96779
US

IV. Provider business mailing address

PO BOX 790569
PAIA HI
96779
US

V. Phone/Fax

Practice location:
  • Phone: 808-579-6070
  • Fax:
Mailing address:
  • Phone: 808-579-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number521
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: