Provider Demographics
NPI:1720675887
Name:PICO, CLAUDETTE MAKALEKA
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:MAKALEKA
Last Name:PICO
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 1:94-670 LUMIAUAU ST # YY102
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5073
Mailing Address - Country:US
Mailing Address - Phone:808-344-8444
Mailing Address - Fax:
Practice Address - Street 1:94-670 LUMIAUAU ST # YY102
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5073
Practice Address - Country:US
Practice Address - Phone:808-344-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT7354208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMAT7354OtherMASSAGE THERAPY