Healthcare Provider Details

I. General information

NPI: 1124937073
Provider Name (Legal Business Name): ANTHONY ACE HEMO MAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-115 AIEA HEIGHTS DR STE 224
AIEA HI
96701-3974
US

IV. Provider business mailing address

99-115 AIEA HEIGHTS DR STE 224
AIEA HI
96701-3974
US

V. Phone/Fax

Practice location:
  • Phone: 808-348-9182
  • Fax: 808-490-0388
Mailing address:
  • Phone: 808-348-9182
  • Fax: 808-490-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-13048
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: