Organization
EAST 2 WEST INTEGRATIVE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTONIO PROVENCIO LAC (ACUPUNCTURIST)
(808) 364-1555
Entity
Organization
Contact information
Practice address
98-199 KAMEHAMEHA HWY STE F3, AIEA, HI 96701
(808) 364-1555
(844) 771-9312
Mailing address
98-199 KAMEHAMEHA HWY STE F3, AIEA, HI 96701-4820
(808) 364-1555
(844) 771-9312
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/14/2018
Last updated
08/01/2018
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