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General NPI Number Information
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NPI Number | 1083238240
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Entity Type | Organization
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Legal Business Name | TENISHA RUIDAS LLC
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 04/28/2022
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Provider Practice Location Address
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Address Line | 99-1255 WAIUA PL UNIT E
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City | AIEA
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State | HI
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Zip | 96701-5620
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Country | US
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Telephone | 808-633-6167
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | AIEA
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State | HI
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Zip | 96701-0309
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TENISHA K RUIDAS
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Credential | LMT
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Telephone | 808-633-6167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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