Healthcare Provider Details

I. General information

NPI: 1447703517
Provider Name (Legal Business Name): ANTONELLA ZAPPADOR LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 KAPIOLANI BLVD SUITE C103
HONOLULU HI
96813-6012
US

IV. Provider business mailing address

PO BOX 25685
HONOLULU HI
96825-0685
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-4650
  • Fax: 808-596-4651
Mailing address:
  • Phone: 808-596-4650
  • Fax: 808-596-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT 10069
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: