Provider Demographics
NPI:1104185230
Name:BAYRAMIAN, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BAYRAMIAN
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 1:123A MIHA PL
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-7913
Mailing Address - Country:US
Mailing Address - Phone:808-772-0290
Mailing Address - Fax:
Practice Address - Street 1:77 HOOKELE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3515
Practice Address - Country:US
Practice Address - Phone:808-270-1893
Practice Address - Fax:808-270-1892
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12726225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist