Individual
JACOB ALAN DOUGLAS LORTIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
74-5078 KUMAKANI ST, KAILUA KONA, HI 96740-1530
(808) 746-1779
Mailing address
74-5078 KUMAKANI ST, KAILUA KONA, HI 96740-1530
(808) 746-1779
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB1375687
HI
Other
Enumeration date
07/22/2025
Last updated
07/22/2025
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