Provider Demographics
NPI:1063819191
Name:ITO, STEVEN
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:ITO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 KAWAIHAE ST APT 148
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1291
Mailing Address - Country:US
Mailing Address - Phone:808-930-9858
Mailing Address - Fax:808-930-9859
Practice Address - Street 1:428 KAWAIHAE ST APT 148
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1291
Practice Address - Country:US
Practice Address - Phone:808-930-9858
Practice Address - Fax:808-930-9859
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001383363LF0000X
HI1875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily