Provider Demographics
NPI:1427937754
Name:ANTONIO, ARCHIE JAMES PASION
Entity type:Individual
Prefix:
First Name:ARCHIE JAMES
Middle Name:PASION
Last Name:ANTONIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1086 PULOKU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3747
Mailing Address - Country:US
Mailing Address - Phone:808-781-8791
Mailing Address - Fax:808-888-7808
Practice Address - Street 1:94-1086 PULOKU ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3747
Practice Address - Country:US
Practice Address - Phone:808-781-8791
Practice Address - Fax:808-888-7808
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-120040253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency