Provider Demographics
NPI:1891904991
Name:DE VERA, ALAIN SOLEDAD (PT)
Entity Type:Individual
Prefix:MR
First Name:ALAIN
Middle Name:SOLEDAD
Last Name:DE VERA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-114 NOHOIHOEWA WAY
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4033
Mailing Address - Country:US
Mailing Address - Phone:808-636-4188
Mailing Address - Fax:808-685-3863
Practice Address - Street 1:HOAUNA ST.
Practice Address - Street 2:
Practice Address - City:KANEOHE,
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:808-247-2472
Practice Address - Fax:808-247-2488
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-2552225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPIN 100995Medicare ID - Type UnspecifiedNAS MEDICARE PART B