Provider Demographics
NPI:1437669769
Name:ALVARADO, KENNETH ANTHONY SR (TLCWELLNESSHAWAII)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ANTHONY
Last Name:ALVARADO
Suffix:SR
Gender:M
Credentials:TLCWELLNESSHAWAII
Other - Prefix:MR
Other - First Name:KENNETH
Other - Middle Name:ANTHONY
Other - Last Name:ALVARADO
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:TLCWELLNESSHAWAII
Mailing Address - Street 1:94-1161 HEAHEA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4713
Mailing Address - Country:US
Mailing Address - Phone:808-773-2520
Mailing Address - Fax:808-200-4013
Practice Address - Street 1:94-1161 HEAHEA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4713
Practice Address - Country:US
Practice Address - Phone:808-773-2520
Practice Address - Fax:808-200-4013
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI82-0889310374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI80-0889310OtherTAX ID