Healthcare Provider Details

I. General information

NPI: 1417878414
Provider Name (Legal Business Name): RAEQUEL ANJILIQUE CRAWFORD LMT, LME
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

734 KAMOKU ST APT 5
HONOLULU HI
96826-4769
US

IV. Provider business mailing address

734 KAMOKU ST APT 5
HONOLULU HI
96826-4769
US

V. Phone/Fax

Practice location:
  • Phone: 808-230-1180
  • Fax:
Mailing address:
  • Phone: 808-230-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT14246
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: