Provider Demographics
NPI:1023595352
Name:PASCUAL, FREDERICK ZANDRE ROBOSA
Entity type:Individual
Prefix:
First Name:FREDERICK ZANDRE
Middle Name:ROBOSA
Last Name:PASCUAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4354 LAAKEA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1965
Mailing Address - Country:US
Mailing Address - Phone:808-769-7126
Mailing Address - Fax:
Practice Address - Street 1:99-128 AIEA HEIGHTS DR STE 207
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3968
Practice Address - Country:US
Practice Address - Phone:808-487-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist