Provider Demographics
NPI:1780177352
Name:PROTACIO, RENATO QUINTO
Entity type:Individual
Prefix:
First Name:RENATO
Middle Name:QUINTO
Last Name:PROTACIO
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 1:198 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-4610
Mailing Address - Country:US
Mailing Address - Phone:808-800-7232
Mailing Address - Fax:888-808-3895
Practice Address - Street 1:198 19TH ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-4610
Practice Address - Country:US
Practice Address - Phone:808-800-7232
Practice Address - Fax:888-808-3895
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIGE-125-946-6752-02374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner