1205874146 NPI number — RONDA SOTO NP

Table of content: DR. AMY MCCAHAN BARRICKLOW D.M.D. (NPI 1891824793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205874146 NPI number — RONDA SOTO NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOTO
Provider First Name:
RONDA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205874146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74-5027A TOMI TOMI DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96740-9626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-987-4506
Provider Business Mailing Address Fax Number:
808-326-9071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65-1267 KAWAIHAE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMUELA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96743-8406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-887-6410
Provider Business Practice Location Address Fax Number:
808-887-6429
Provider Enumeration Date:
06/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  A0404453 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LA2200X , with the licence number: APRN-RX 145 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000024896-3 . This is a "HMSA OFFICE SITE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00A024896-1 . This is a "HMSA LIFE CARE CENTER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 00B024896-9 . This is a "HMSA KONA HOSPITAL LTC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 560616-03 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 560616-02 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: H101043 . This is a "MEDICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 560616-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: HMSA . This is a "74-5027A TOMI TOMI DRIVE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 56061605 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00D0248965 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 3866653 . This is a "UNIVERSITY HEALTH ALLIANC" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 57614 . This is a "MEDICARE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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