Provider Demographics
NPI:1962236901
Name:MA'AE, LOLEGI S
Entity type:Individual
Prefix:
First Name:LOLEGI
Middle Name:S
Last Name:MA'AE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-1144 KAMEHAMEHA HWY STE 200&500
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3244
Mailing Address - Country:US
Mailing Address - Phone:808-247-9408
Mailing Address - Fax:808-824-3209
Practice Address - Street 1:45-1144 KAMEHAMEHA HWY STE 200&500
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3244
Practice Address - Country:US
Practice Address - Phone:808-247-9408
Practice Address - Fax:808-824-3209
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17783225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist