Healthcare Provider Details

I. General information

NPI: 1740176734
Provider Name (Legal Business Name): KEHAU NAPUALANI REBOLLEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18351 BEACH BLVD STE B
HUNTINGTON BEACH CA
92648-1346
US

IV. Provider business mailing address

1710 CALIFORNIA ST APT 4
HUNTINGTON BEACH CA
92648-3148
US

V. Phone/Fax

Practice location:
  • Phone: 714-913-3310
  • Fax:
Mailing address:
  • Phone: 619-990-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number40201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: