Provider Demographics
NPI:1518083286
Name:MOLCZADZKI, RICARDO
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:
Last Name:MOLCZADZKI
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:PO BOX 790569
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779
Mailing Address - Country:US
Mailing Address - Phone:808-579-6070
Mailing Address - Fax:
Practice Address - Street 1:42 BALDWIN AVE
Practice Address - Street 2:
Practice Address - City:PAIA
Practice Address - State:HI
Practice Address - Zip Code:96779
Practice Address - Country:US
Practice Address - Phone:808-579-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI20-0282792OtherTAX ID NUMBER