Provider Demographics
NPI:1053642926
Name:LUCAS, MELY ROSE CABASUG (LMT)
Entity Type:Individual
Prefix:MISS
First Name:MELY ROSE
Middle Name:CABASUG
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1594 ELUA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3661
Mailing Address - Country:US
Mailing Address - Phone:808-358-0839
Mailing Address - Fax:
Practice Address - Street 1:3566 HARDING AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2457
Practice Address - Country:US
Practice Address - Phone:808-358-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11567225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist