Provider Demographics
NPI:1962004507
Name:PASCUAL, MARIO (CNA)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:PASCUAL
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-1258 KALEO PL
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1536
Mailing Address - Country:US
Mailing Address - Phone:808-228-6858
Mailing Address - Fax:
Practice Address - Street 1:92-1258 KALEO PL
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1536
Practice Address - Country:US
Practice Address - Phone:808-228-6858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8214323174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty