Provider Demographics
NPI:1093279598
Name:NAKAGAWA, MARILOU G (MAT-15629, LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARILOU
Middle Name:G
Last Name:NAKAGAWA
Suffix:
Gender:F
Credentials:MAT-15629, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2254
Mailing Address - Country:US
Mailing Address - Phone:808-497-2323
Mailing Address - Fax:808-593-8035
Practice Address - Street 1:1281 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2254
Practice Address - Country:US
Practice Address - Phone:808-593-8866
Practice Address - Fax:808-593-8035
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15629225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty