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General NPI Number Information
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NPI Number | 1609262112
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Entity Type | Individual
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Provider Name | MICHAEL CERASO L.AC.
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Gender | Male
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Dates
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Enumeration Date | 04/10/2015
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Last Update Date | 04/10/2015
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Provider Practice Location Address
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Address Line | 12-6860 KAPOHO-KALAPANA RD
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City | PAHOA
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State | HI
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Zip | 96778
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Country | US
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Telephone | 808-965-0354
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Fax |
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Provider Business Mailing Address
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Address Line | 12-6860 KAPOHO-KALAPANA RD
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City | PAHOA
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State | HI
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Zip | 96778
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Country | US
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Telephone | 808-965-0354
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | ACU-1101
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License Number State | HI
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