Provider Demographics
NPI:1992103790
Name:ANTONIO, BIANCA SOPHIA
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:SOPHIA
Last Name:ANTONIO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:BIANCA
Other - Middle Name:SOPHIA
Other - Last Name:AUERSWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:78 ALIILANI PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-9033
Mailing Address - Country:US
Mailing Address - Phone:808-250-8870
Mailing Address - Fax:
Practice Address - Street 1:78 ALIILANI PL
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-9033
Practice Address - Country:US
Practice Address - Phone:808-250-8870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst