Healthcare Provider Details

I. General information

NPI: 1811068000
Provider Name (Legal Business Name): MARYANN BARROS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KAULUWEHI PL
KULA HI
96790-7231
US

IV. Provider business mailing address

PO BOX 156
KULA HI
96790-0156
US

V. Phone/Fax

Practice location:
  • Phone: 808-573-9339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4943
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: