Provider Demographics
NPI:1538793559
Name:LANOZA, BLAKE T JR
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:T
Last Name:LANOZA
Suffix:JR
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 1:94-1390 WELINA LOOP APT W
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4158
Mailing Address - Country:US
Mailing Address - Phone:808-782-5213
Mailing Address - Fax:
Practice Address - Street 1:203 KAPAA QUARRY PL.
Practice Address - Street 2:#5002
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734
Practice Address - Country:US
Practice Address - Phone:808-247-2973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician