Healthcare Provider Details

I. General information

NPI: 1164378956
Provider Name (Legal Business Name): ADVANCED MASSAGE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1037 PUUAINAKO PL
EWA BEACH HI
96706-4721
US

IV. Provider business mailing address

91-1045 NIOLO ST
EWA BEACH HI
96706-5118
US

V. Phone/Fax

Practice location:
  • Phone: 808-729-8391
  • Fax: 808-762-0490
Mailing address:
  • Phone: 808-729-8391
  • Fax: 808-762-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA TANJOCO
Title or Position: CEO
Credential: LMT
Phone: 808-729-8391