Healthcare Provider Details

I. General information

NPI: 1588082317
Provider Name (Legal Business Name): WADE MASAKI HASHIMOTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 03/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 PUUNOA PL APT A
HONOLULU HI
96816-3463
US

IV. Provider business mailing address

2440 PUUNOA PL APT A
HONOLULU HI
96816-3463
US

V. Phone/Fax

Practice location:
  • Phone: 808-312-8919
  • Fax:
Mailing address:
  • Phone: 808-312-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMAT-13742
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: