Provider Demographics
NPI:1427795087
Name:SIU, AMBER TIANA
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:TIANA
Last Name:SIU
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 1:64-1040 MAMALAHOA HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8450
Mailing Address - Country:US
Mailing Address - Phone:808-217-6951
Mailing Address - Fax:
Practice Address - Street 1:64-1040 MAMALAHOA HWY STE 201
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8450
Practice Address - Country:US
Practice Address - Phone:808-217-6951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15205225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty