Healthcare Provider Details

I. General information

NPI: 1811067218
Provider Name (Legal Business Name): BIANCA M KUSATSU LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-128 AIEA HEIGHTS DR SUITE 101A
AIEA HI
96701-3925
US

IV. Provider business mailing address

99-128 AIEA HEIGHTS DR SUITE 101A
AIEA HI
96701-3925
US

V. Phone/Fax

Practice location:
  • Phone: 808-485-0885
  • Fax: 808-485-0884
Mailing address:
  • Phone: 808-485-0885
  • Fax: 808-485-0884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT5377
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: