Basic Information
| Provider Information | |||||||||
| NPI: | 1932462736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAVELLE | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | VALERIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 970 N KALAHEO AVE | ||||||||
| Address2: | STE C316 | ||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967341883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084885555 | ||||||||
| FaxNumber: | 8083126363 | ||||||||
| Practice Location | |||||||||
| Address1: | 1188 BISHOP ST | ||||||||
| Address2: | STE 3311 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968133301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087385601 | ||||||||
| FaxNumber: | 8085369187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 12/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 476 | HI | N | Other Service Providers | Acupuncturist | 225100000X | 1360 | HI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.