Provider Demographics
NPI:1629386255
Name:ST ONGE, RICHARD ANTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTON
Last Name:ST ONGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59-003 HUELO ST
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-9711
Mailing Address - Country:US
Mailing Address - Phone:808-638-5294
Mailing Address - Fax:
Practice Address - Street 1:59-003 HUELO ST
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-9711
Practice Address - Country:US
Practice Address - Phone:808-638-5294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HISL003596174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator