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General NPI Number Information
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NPI Number | 1447403704
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Entity Type | Individual
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Provider Name | MELISSA ANN MATUTINO LMT
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Gender | Female
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Dates
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Enumeration Date | 10/30/2008
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 803 KAMEHAMEHA HWY STE 416F
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City | PEARL CITY
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State | HI
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Zip | 96782-2638
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Country | US
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Telephone | 808-455-4448
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Fax | 808-455-4442
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Provider Business Mailing Address
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Address Line | 92-1148 PANANA ST APT 239
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City | KAPOLEI
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State | HI
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Zip | 96707-1466
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Country | US
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Telephone | 808-688-4135
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Fax | 808-455-4442
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 110001
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License Number State | HI
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