Healthcare Provider Details

I. General information

NPI: 1679088967
Provider Name (Legal Business Name): RYLEE K URASAKI LMT, MMP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2017
Last Update Date: 12/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 KEOLU DR STE 102
KAILUA HI
96734-3871
US

IV. Provider business mailing address

47-387 HUI IWA ST APT 4
KANEOHE HI
96744-4435
US

V. Phone/Fax

Practice location:
  • Phone: 808-262-2292
  • Fax: 808-262-2293
Mailing address:
  • Phone: 808-218-4274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15308
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: