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General NPI Number Information
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NPI Number | 1508319591
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Entity Type | Organization
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Legal Business Name | BARONESA LLC
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 34 WAILEA GATEWAY PL 203
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City | KIHEI
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State | HI
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Zip | 96753-6525
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Country | US
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Telephone | 808-875-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 34 WAILEA GATEWAY PL 203
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City | KIHEI
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State | HI
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Zip | 96753-6525
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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 | SPA MANAGER
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Name | IVANA SLAVIK
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Credential |
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Telephone | 808-875-1313
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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 | HI
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