Provider Demographics
NPI:1245301688
Name:MACY, ANA-MARITZA ITZEL (DLAC OMD)
Entity type:Individual
Prefix:
First Name:ANA-MARITZA
Middle Name:ITZEL
Last Name:MACY
Suffix:
Gender:F
Credentials:DLAC OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-035 KUAHELANI AVE
Mailing Address - Street 2:APT.125
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1759
Mailing Address - Country:US
Mailing Address - Phone:808-778-2848
Mailing Address - Fax:
Practice Address - Street 1:2490 KALAKAUA AVE
Practice Address - Street 2:4TH. FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3240
Practice Address - Country:US
Practice Address - Phone:808-441-4890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI663171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI663OtherACUPUNCTURE LICENCE
HIMM1041953OtherASH PROVIDER