Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MAT10923 | HI |
NPI | 1003289695 |
---|---|
Provider Name | Cecelia Marrone |
First Address | Kapolei, HI 96707-2009 |
Second Address | Kapolei, HI 96707-1881 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2015 |
Last Update Date | 04/11/2015 |