Healthcare Provider Details

I. General information

NPI: 1154609543
Provider Name (Legal Business Name): NOA CAISERMAN MAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-5649 MAMALAHOA HWY NOAS ISLAND MASSAGE
NA'ALEHU HI
96772
US

IV. Provider business mailing address

PO BOX 782
PAHALA HI
96777
US

V. Phone/Fax

Practice location:
  • Phone: 808-756-3183
  • Fax:
Mailing address:
  • Phone: 808-756-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMAT6366
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: