Provider Demographics
NPI:1558117176
Name:ANDRADE, SERGIO (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:ANDRADE
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SPENCER ST APT 803
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3741
Mailing Address - Country:US
Mailing Address - Phone:808-780-7526
Mailing Address - Fax:
Practice Address - Street 1:931 UNIVERSITY AVE STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3241
Practice Address - Country:US
Practice Address - Phone:808-373-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-17848-0225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist