Healthcare Provider Details

I. General information

NPI: 1063990703
Provider Name (Legal Business Name): MONIQUE OBRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 08/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 S KING ST STE 339
HONOLULU HI
96814-2604
US

IV. Provider business mailing address

1481 S KING ST STE 339
HONOLULU HI
96814-2604
US

V. Phone/Fax

Practice location:
  • Phone: 720-737-7704
  • Fax:
Mailing address:
  • Phone: 720-737-7704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12681
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: