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General NPI Number Information
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NPI Number | 1558117176
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Entity Type | Individual
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Provider Name | SERGIO ANDRADE MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 05/21/2024
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Provider Practice Location Address
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Address Line | 931 UNIVERSITY AVE STE 202
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City | HONOLULU
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State | HI
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Zip | 96826-3241
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Country | US
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Telephone | 808-373-0603
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Fax |
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Provider Business Mailing Address
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Address Line | 905 SPENCER ST APT 803
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City | HONOLULU
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State | HI
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Zip | 96822-3741
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Country | US
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Telephone | 808-780-7526
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAT-17848-0
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License Number State | HI
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