Active NPI
Michael Fredeluces
- Behavior Technician
- Honolulu, HI
National Provider Identifier
1710449285
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 16-17068
- Practice address
- 4510 Salt Lake Blvd Ste D8
Honolulu, HI 96818-3172 - Phone
- (808) 486-1804
- Fax
- (808) 486-9199
- NPI assigned
- Apr 3, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 16-17068 | HI | Primary |
Addresses
Primary practice location
4510 Salt Lake Blvd Ste D8
Honolulu, HI 96818-3172
Mailing address
4510 Salt Lake Blvd Ste D8
Honolulu, HI 96818-3172
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16-17068 | HI | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| B.C.P., Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Home Health Agency
- Honolulu, HI
- NPI 1215378054
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554249600000",
"number": "1710449285",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4510 SALT LAKE BLVD STE D8",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968183172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4510 SALT LAKE BLVD STE D8",
"city": "HONOLULU",
"state": "HI",
"postal_code": "968183172",
"telephone_number": "808-486-1804",
"fax_number": "808-486-9199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREDELUCES",
"first_name": "MICHAEL",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-04-03",
"last_updated": "2019-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "HI",
"license": "16-17068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Honolulu, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.