Provider Demographics
NPI:1699702183
Name:REZENTES, WILLIAM III (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:REZENTES
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:REZENTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1733 AKAAKOA ST
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4206
Mailing Address - Country:US
Mailing Address - Phone:808-262-4994
Mailing Address - Fax:
Practice Address - Street 1:1733 AKAAKOA ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4206
Practice Address - Country:US
Practice Address - Phone:808-262-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-397103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI05461402Medicaid
HIB6298-0OtherHMSA PROVIDER NUMBER
HIB6298-0OtherHMSA PROVIDER NUMBER