Provider Demographics
NPI:1740835156
Name:CADIZ, MITCH
Entity type:Individual
Prefix:
First Name:MITCH
Middle Name:
Last Name:CADIZ
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 1:1048B HORNER ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-2415
Mailing Address - Country:US
Mailing Address - Phone:808-237-0130
Mailing Address - Fax:808-845-2630
Practice Address - Street 1:1048B HORNER ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-2415
Practice Address - Country:US
Practice Address - Phone:808-237-0130
Practice Address - Fax:808-845-2630
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-03
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency