Provider Demographics
NPI:1396458659
Name:DEGUZMAN-BARTELS, RACQUEL KAHULA KAHEALANI
Entity type:Individual
Prefix:
First Name:RACQUEL
Middle Name:KAHULA KAHEALANI
Last Name:DEGUZMAN-BARTELS
Suffix:
Gender:F
Credentials:
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 901
Mailing Address - Street 2:
Mailing Address - City:KEAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96749-0901
Mailing Address - Country:US
Mailing Address - Phone:808-494-9290
Mailing Address - Fax:
Practice Address - Street 1:15-1686 8TH AVE
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749
Practice Address - Country:US
Practice Address - Phone:808-494-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty