Provider Demographics
NPI:1528497310
Name:ROSA, ERLINDA (MT)
Entity type:Individual
Prefix:
First Name:ERLINDA
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-0855
Mailing Address - Country:US
Mailing Address - Phone:808-651-4520
Mailing Address - Fax:808-822-3061
Practice Address - Street 1:931 KIPUNI WAY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1571
Practice Address - Country:US
Practice Address - Phone:808-651-4520
Practice Address - Fax:808-256-4678
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6480225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist