Provider Demographics
NPI:1306062336
Name:ARCHIBEQUE, T NALANI (PHD)
Entity type:Individual
Prefix:DR
First Name:T
Middle Name:NALANI
Last Name:ARCHIBEQUE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880454
Mailing Address - Street 2:
Mailing Address - City:PUKALANI
Mailing Address - State:HI
Mailing Address - Zip Code:96788
Mailing Address - Country:US
Mailing Address - Phone:808-573-6666
Mailing Address - Fax:
Practice Address - Street 1:1043 MAKAWAO AVE
Practice Address - Street 2:202B
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768
Practice Address - Country:US
Practice Address - Phone:808-573-6666
Practice Address - Fax:808-876-0077
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI253103TC0700X
AZ901103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02484801Medicaid
HIS33048OtherKAISER
HI02484801Medicaid
HI0000TCBNPMedicare ID - Type Unspecified