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General NPI Number Information
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NPI Number | 1083438204
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Entity Type | Individual
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Provider Name | RAY VICENTE SAN NICOLAS PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 3221 WAIALAE AVE STE 300
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City | HONOLULU
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State | HI
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Zip | 96816-5845
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Country | US
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Telephone | 808-737-4244
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Fax |
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Provider Business Mailing Address
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Address Line | 3138 WAIALAE AVE APT 313
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City | HONOLULU
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State | HI
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Zip | 96816-1540
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Country | US
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Telephone | 808-225-9767
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | HI
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