=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861004681
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TERI ZAMBO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2020
-----------------------------------------------------
Last Update Date | 08/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15-2714 PAHOA VILLAGE RD
-----------------------------------------------------
City | PAHOA
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96778-9715
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-633-1944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 493042
-----------------------------------------------------
City | KEAAU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96749-3042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-633-1944
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 6926
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------