Healthcare Provider Details

I. General information

NPI: 1477291946
Provider Name (Legal Business Name): MARIA-THEA VISAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 KAPIOLANI BLVD STE 800
HONOLULU HI
96814-4536
US

IV. Provider business mailing address

627A N SCHOOL ST
HONOLULU HI
96817-3029
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-9043
  • Fax: 808-526-0268
Mailing address:
  • Phone: 808-358-8801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT6653
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: