Provider Demographics
NPI:1033749338
Name:DEMA-ALA, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DEMA-ALA
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 1:590 FARRINGTON HWY # 524-257
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2009
Mailing Address - Country:US
Mailing Address - Phone:808-426-0415
Mailing Address - Fax:808-800-2436
Practice Address - Street 1:2176 LAUWILIWILI ST STE OFFICE38
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1881
Practice Address - Country:US
Practice Address - Phone:808-426-0415
Practice Address - Fax:808-800-2436
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-16326225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist