Provider Demographics
NPI:1962066852
Name:VILLENA, DANIE VALDEZ JR (LMT)
Entity type:Individual
Prefix:MR
First Name:DANIE
Middle Name:VALDEZ
Last Name:VILLENA
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:294 KIAI PL
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5476
Mailing Address - Country:US
Mailing Address - Phone:808-345-1995
Mailing Address - Fax:
Practice Address - Street 1:154 HOLOMUA ST STE 201
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5133
Practice Address - Country:US
Practice Address - Phone:808-345-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-156000225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist