Healthcare Provider Details

I. General information

NPI: 1912825308
Provider Name (Legal Business Name): MIND BODY MEDICAL SERVICES FL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N KALAHEO AVE APT D
KAILUA HI
96734-5803
US

IV. Provider business mailing address

111 HEKILI ST STE A
KAILUA HI
96734-2800
US

V. Phone/Fax

Practice location:
  • Phone: 240-338-0567
  • Fax:
Mailing address:
  • Phone: 240-338-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LEO DAMASCO
Title or Position: OWNER
Credential: MD
Phone: 240-338-0567