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General NPI Number Information
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NPI Number | 1861294068
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Entity Type | Individual
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Provider Name | AMANDA TAVAREZ
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Gender | Female
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Dates
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Enumeration Date | 03/26/2025
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 75-127 LUNAPULE RD STE 1A
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City | KAILUA KONA
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State | HI
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Zip | 96740-2112
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Country | US
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Telephone | 226-380-8769
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Fax |
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Provider Business Mailing Address
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Address Line | 76-6195 PAKALANA RD UNIT 2
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City | KAILUA KONA
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State | HI
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Zip | 96740-2205
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Country | US
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Telephone | 929-329-4132
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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-18113-0
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License Number State | HI
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