Healthcare Provider Details

I. General information

NPI: 1134415730
Provider Name (Legal Business Name): JAMIE IWAMOTO L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2011
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 KAHOA DRIVE
KAILUA HI
96734
US

IV. Provider business mailing address

709 KAHOA DR
KAILUA HI
96734-2439
US

V. Phone/Fax

Practice location:
  • Phone: 808-261-6216
  • Fax:
Mailing address:
  • Phone: 808-261-6216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number12090
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: