=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467103150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WELLNESS & MASSAGE HALEMANA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/13/2022
-----------------------------------------------------
Last Update Date | 01/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4211 WAIALAE AVE STE 206A
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816-5312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-688-3861
-----------------------------------------------------
Fax | 808-425-4288
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4211 WAIALAE AVE STE 206A
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96816-5312
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-688-3861
-----------------------------------------------------
Fax | 808-425-4288
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AKIKO ISHIZUKA FREI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-688-3861
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------