Provider Demographics
NPI:1306658851
Name:GARCIA, SAMUEL EZEKIEL (N/A)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EZEKIEL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24A DERBY LN
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4222
Mailing Address - Country:US
Mailing Address - Phone:971-804-0342
Mailing Address - Fax:
Practice Address - Street 1:214 WAIANUENUE AVE STE 209
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2489
Practice Address - Country:US
Practice Address - Phone:808-961-7000
Practice Address - Fax:808-961-7099
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician