Healthcare Provider Details

I. General information

NPI: 1821913567
Provider Name (Legal Business Name): AYAKA COSTA LMT
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FURNEAUX LN STE 207
HILO HI
96720-2879
US

IV. Provider business mailing address

17 FURNEAUX LN STE 207
HILO HI
96720-2879
US

V. Phone/Fax

Practice location:
  • Phone: 808-769-3830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-10922
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: