Healthcare Provider Details

I. General information

NPI: 1881282051
Provider Name (Legal Business Name): NICOLE BERINOBIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65-1235 OPELO RD STE 8
KAMUELA HI
96743-8454
US

IV. Provider business mailing address

64-197 PUU PULEHU LOOP
KAMUELA HI
96743-8021
US

V. Phone/Fax

Practice location:
  • Phone: 808-896-9188
  • Fax:
Mailing address:
  • Phone: 808-896-9188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE MARIE BERINOBIS
Title or Position: OWNER/LMT
Credential: LMT
Phone: 808-896-9188