Healthcare Provider Details

I. General information

NPI: 1629142005
Provider Name (Legal Business Name): VICTORIA JO WRIGHT L. AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3783 MILIMAKANI PLACE
PRINCEVILLE HI
96722
US

IV. Provider business mailing address

PO BOX 933
KILAUEA HI
96754-0933
US

V. Phone/Fax

Practice location:
  • Phone: 808-826-9095
  • Fax:
Mailing address:
  • Phone: 808-826-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number264
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: