Healthcare Provider Details

I. General information

NPI: 1518275908
Provider Name (Legal Business Name): THE COCOCNUT GIRLS.COM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74-5583 LUHIA ST
KAILUA KONA HI
96740-3624
US

IV. Provider business mailing address

PO BOX 10
HOLUALOA HI
96725-0010
US

V. Phone/Fax

Practice location:
  • Phone: 808-937-2515
  • Fax:
Mailing address:
  • Phone: 808-937-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMAE 2288
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAE 2288
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMAE 2288
License Number StateHI

VIII. Authorized Official

Name: MICHELLE MCKEON
Title or Position: PRESIDENT
Credential: MAT
Phone: 808-937-2515