Antonio Provencio, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

Practice address

98-199 Kamehameha Hwy Ste F3
Aiea, HI 96701

Phone

(808) 364-1555

NPI assigned

Feb 17, 2018

Last updated

Jul 29, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• East 2 West Acupuncture & Massage LLC

  • Clinic/Center
  • Waipahu, HI
  • NPI 1932772449
  NPD Authorized official
• East 2 West Integrative Medicine LLC

  • Clinic/Center
  • Aiea, HI
  • NPI 1740780949

  Acupuncturist

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532822400000",
    "number": "1821598699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98-199 KAMEHAMEHA HWY STE F3",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "967014820",
            "telephone_number": "808-364-1555",
            "fax_number": "844-771-9312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "98-199 KAMEHAMEHA HWY STE F3",
            "city": "AIEA",
            "state": "HI",
            "postal_code": "96701",
            "telephone_number": "808-364-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVENCIO",
        "first_name": "ANTONIO",
        "credential": "LAC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-02-17",
        "last_updated": "2018-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "HI",
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACUPUNCTURE STATE LICENSE",
            "identifier": "1231",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACUPUNCTURE STATE LICENSE",
            "identifier": "17178",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR EAST 2 WEST INTEGRATIVE MEDICINE",
            "identifier": "1740780949",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Acupuncturist in Aiea, HI
• Providers in Aiea, HI by specialty
• Acupuncturist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.