Healthcare Provider Details

I. General information

NPI: 1346157880
Provider Name (Legal Business Name): SERAFIMA CARLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 MAMO ST
HILO HI
96720-2956
US

IV. Provider business mailing address

97 OLONA ST UNIT 105
HILO HI
96720-8013
US

V. Phone/Fax

Practice location:
  • Phone: 809-557-4903
  • Fax:
Mailing address:
  • Phone: 808-557-4903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-17766
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: