Provider Demographics
NPI:1497055578
Name:GITZEL, KIMBERLY (LAC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GITZEL
Suffix:
Gender:F
Credentials:LAC
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 6925
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-8936
Mailing Address - Country:US
Mailing Address - Phone:808-938-6007
Mailing Address - Fax:
Practice Address - Street 1:83 MAIKAI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5364
Practice Address - Country:US
Practice Address - Phone:808-938-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-23
Last Update Date:2010-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU-720171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist