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General NPI Number Information
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NPI Number | 1619268968
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Entity Type | Organization
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Legal Business Name | PAU HANA MASSAGE LLC
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Dates
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Enumeration Date | 04/20/2011
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 75-5741 KUAKINI HWY #A
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City | KAILUA KONA
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State | HI
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Zip | 96740-3724
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Country | US
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Telephone | 808-327-5664
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Fax |
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Provider Business Mailing Address
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Address Line | 75-5741 KUAKINI HWY #A
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City | KAILUA KONA
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State | HI
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Zip | 96740-3724
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Country | US
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Telephone | 808-327-5664
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | PUALILIA A PAIKULI
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Credential | LMT
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Telephone | 808-327-5664
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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 | 2596
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License Number State | HI
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