MEDICARE: REGINA VALERIE LAVELLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	476	HI
2	225100000X	Physical Therapist	1360	HI

General Provider Information

NPI Number	:	1932462736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA VALERIE LAVELLE

Provider Business Mailing Address
First Line	:	970 N KALAHEO AVE
Second Line	:	STE C316
City	:	KAILUA
State	:	HI
Zip	:	96734-1883
Country	:	US
Telephone Number	:	808-488-5555
Fax Number	:	808-312-6363

Provider Business Practice Location Address
First Line	:	1188 BISHOP ST
Second Line	:	STE 3311
City	:	HONOLULU
State	:	HI
Zip	:	96813-3301
Country	:	US
Telephone Number	:	808-738-5601
Fax Number	:	808-536-9187

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2012
Last Update Date	:	12/28/2016

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Directions to “ REGINA VALERIE LAVELLE ” Practice Location

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