Healthcare Provider Details

I. General information

NPI: 1386127116
Provider Name (Legal Business Name): EVITA MARIE HUAPAYA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1827 WELLS ST STE 2
WAILUKU HI
96793-2370
US

IV. Provider business mailing address

1827 WELLS ST STE 2
WAILUKU HI
96793-2370
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-0077
  • Fax:
Mailing address:
  • Phone: 808-244-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number15671
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: