Individual
ANTONIO PROVENCIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
98-199 KAMEHAMEHA HWY STE F3, AIEA, HI 96701
(808) 364-1555
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
—
CA
171100000X
Acupuncturist
Primary
—
HI
225700000X
Massage Therapist
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1231
ACUPUNCTURE STATE LICENSE
HI
01
—
17178
ACUPUNCTURE STATE LICENSE
CA
01
—
1740780949
NPI FOR EAST 2 WEST INTEGRATIVE MEDICINE
—
Enumeration date
02/17/2018
Last updated
07/29/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us