Provider Demographics
NPI:1417799701
Name:TRAHAN, CARLOS JUDE (MAT-3694)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:JUDE
Last Name:TRAHAN
Suffix:
Gender:M
Credentials:MAT-3694
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 WARD AVE # 106-270
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4010
Mailing Address - Country:US
Mailing Address - Phone:808-373-0416
Mailing Address - Fax:
Practice Address - Street 1:350 WARD AVE # 106-270
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4010
Practice Address - Country:US
Practice Address - Phone:808-373-0416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-3694225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist