1710511100 NPI number — LIGHTHOUSE THERAPY & DIAGNOSTIC SERVICES

Table of content: MRS. RAMONA RAMIREZ DE PEREZ (NPI 1578048419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710511100 NPI number — LIGHTHOUSE THERAPY & DIAGNOSTIC SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIGHTHOUSE THERAPY & DIAGNOSTIC SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1710511100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5108 KUHINA PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCEVILLE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96722-5116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-652-0466
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2509 KOLO ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILAUEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-652-0466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2020

Additional Information

Authorized Official

Authorized Official Last Name:
LUDOLPH
Authorized Official First Name:
SHELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
808-652-0466

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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