Provider Demographics
NPI:1588454946
Name:RICCIO, MARK (LMT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:RICCIO
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 LIHOLIHO ST APT 1102
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-2912
Mailing Address - Country:US
Mailing Address - Phone:808-638-1396
Mailing Address - Fax:
Practice Address - Street 1:1616 LIHOLIHO ST APT 1102
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-2912
Practice Address - Country:US
Practice Address - Phone:808-638-1396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17737225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist