Provider Demographics
NPI:1336462456
Name:STASIK, GLORIA (DAC)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:STASIK
Suffix:
Gender:F
Credentials:DAC
Other - Prefix:
Other - First Name:GLOIRA
Other - Middle Name:REYES
Other - Last Name:STASIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAC
Mailing Address - Street 1:627 SOUTH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5050
Mailing Address - Country:US
Mailing Address - Phone:808-371-9391
Mailing Address - Fax:808-485-2059
Practice Address - Street 1:627 SOUTH ST
Practice Address - Street 2:SUITE 3
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5050
Practice Address - Country:US
Practice Address - Phone:808-371-9391
Practice Address - Fax:808-485-2059
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAC 609171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist