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General NPI Number Information
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NPI Number | 1164075040
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Entity Type | Organization
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Legal Business Name | MAUI INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 233 S MARKET ST
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City | WAILUKU
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State | HI
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Zip | 96793-2218
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Country | US
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Telephone | 310-529-6891
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Fax |
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Provider Business Mailing Address
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Address Line | 72 MANO DR
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City | KULA
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State | HI
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Zip | 96790-8527
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Country | US
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Telephone | 310-529-6891
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELLE KELSO BINZAK
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Credential | LAC
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Telephone | 310-529-6891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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