Provider Demographics
NPI:1598161218
Name:RENTERIA, DANIEL GABRIEL NA HIKU (ATC, LMT)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:GABRIEL NA HIKU
Last Name:RENTERIA
Suffix:
Gender:M
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:PEPEEKEO
Mailing Address - State:HI
Mailing Address - Zip Code:96783-0188
Mailing Address - Country:US
Mailing Address - Phone:808-895-1616
Mailing Address - Fax:
Practice Address - Street 1:155 W KAWILI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5038
Practice Address - Country:US
Practice Address - Phone:808-974-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI832255A2300X
HI10008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist