Healthcare Provider Details

I. General information

NPI: 1639401540
Provider Name (Legal Business Name): SERENITY AND MASSAGE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 KEAHOLE ST STE 207
HONOLULU HI
96825-3405
US

IV. Provider business mailing address

377 KEAHOLE ST STE 207
HONOLULU HI
96825-3405
US

V. Phone/Fax

Practice location:
  • Phone: 808-396-7594
  • Fax: 808-396-7594
Mailing address:
  • Phone: 808-396-7594
  • Fax: 808-396-7594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberMAE-2184
License Number StateHI

VIII. Authorized Official

Name: MISS SANDRA YVONNE STENEN
Title or Position: OWNER
Credential: LMT
Phone: 808-396-7594