Provider Demographics
NPI:1487903225
Name:MCINTOSH, RIZALIE A
Entity type:Individual
Prefix:
First Name:RIZALIE
Middle Name:A
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-185 MIKANA ST # B
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3728
Mailing Address - Country:US
Mailing Address - Phone:808-888-0854
Mailing Address - Fax:808-888-0854
Practice Address - Street 1:87-185 MIKANA ST # B
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3728
Practice Address - Country:US
Practice Address - Phone:808-888-0854
Practice Address - Fax:808-888-0854
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH1100717010376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator