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General NPI Number Information
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NPI Number | 1184091043
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Entity Type | Organization
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Legal Business Name | SOULISTIC HOLISTICS HAWAII LLC
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 46-024 KAMEHAMEHA HWY #210
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City | KANEOHE
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State | HI
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Zip | 96744-3714
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Country | US
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Telephone | 808-721-3083
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Fax |
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Provider Business Mailing Address
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Address Line | 46-063 EMEPELA PL V/100
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City | KANEOHE
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State | HI
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Zip | 96744-3947
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Country | US
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Telephone | 808-721-3083
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST/OWNER
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Name | MRS. SORAYA FARIS APPLEGATE
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Credential | L.AC
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Telephone | 808-721-3083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1133
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License Number State | HI
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