Provider Demographics
NPI:1306444575
Name:AIPOALANI, ELENOA KALEI (LMT)
Entity type:Individual
Prefix:
First Name:ELENOA
Middle Name:KALEI
Last Name:AIPOALANI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7069
Mailing Address - Country:US
Mailing Address - Phone:510-999-2826
Mailing Address - Fax:
Practice Address - Street 1:1240 CENTRAL BLVD STE A3
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2228
Practice Address - Country:US
Practice Address - Phone:510-999-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist