Provider Demographics
NPI:1114231073
Name:CACPAL, TERESITA R
Entity Type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:R
Last Name:CACPAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-0680
Mailing Address - Country:US
Mailing Address - Phone:808-966-9588
Mailing Address - Fax:
Practice Address - Street 1:151364 PONI MOI ST.
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-0680
Practice Address - Country:US
Practice Address - Phone:808-966-9588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide