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General NPI Number Information
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NPI Number | 1912613530
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Entity Type | Individual
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Provider Name | MARK ILAGAN LMT
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Gender | Male
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 2024 N KING ST STE 109
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City | HONOLULU
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State | HI
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Zip | 96819-3470
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Country | US
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Telephone | 808-847-2644
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Fax | 808-847-2624
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Provider Business Mailing Address
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Address Line | 775 MCNEILL ST APT 118B
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City | HONOLULU
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State | HI
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Zip | 96817-4218
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Country | US
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Telephone | 808-358-5751
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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 | 10320
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License Number State | HI
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