Provider Demographics
NPI:1407680853
Name:GARCIA-RAQUEL, HAYLEE
Entity type:Individual
Prefix:
First Name:HAYLEE
Middle Name:
Last Name:GARCIA-RAQUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5634 KULA MAUU ST
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2521
Mailing Address - Country:US
Mailing Address - Phone:808-652-3359
Mailing Address - Fax:
Practice Address - Street 1:5634 KULA MAUU ST
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-2521
Practice Address - Country:US
Practice Address - Phone:808-652-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-17717-0225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist