Healthcare Provider Details

I. General information

NPI: 1699495747
Provider Name (Legal Business Name): ROCHELLE LANGIT CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1357 KAPIOLANI BLVD
HONOLULU HI
96814-4549
US

IV. Provider business mailing address

3461 ALOHEA AVE
HONOLULU HI
96816-2262
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-9043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT170410
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: