Provider Demographics
NPI:1922351980
Name:DICOSMO, ERICA LYNNE (LAC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNNE
Last Name:DICOSMO
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 2382
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-2382
Mailing Address - Country:US
Mailing Address - Phone:808-333-4282
Mailing Address - Fax:
Practice Address - Street 1:65-1267 KAWAIHAE RD
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7345
Practice Address - Country:US
Practice Address - Phone:808-887-2020
Practice Address - Fax:808-887-2021
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU - 1037171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist