Healthcare Provider Details

I. General information

NPI: 1477324721
Provider Name (Legal Business Name): CINDY PINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 KUPAOA ST # B-201
MAKAWAO HI
96768-6215
US

IV. Provider business mailing address

2375 OLINDA RD
MAKAWAO HI
96768-7136
US

V. Phone/Fax

Practice location:
  • Phone: 808-872-0077
  • Fax:
Mailing address:
  • Phone: 205-836-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT-15627
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: