Provider Demographics
NPI:1225435076
Name:KOZMIDI, ELENA Y (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:Y
Last Name:KOZMIDI
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:ELENA
Other - Middle Name:Y
Other - Last Name:KOZMIDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 383882
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-3882
Mailing Address - Country:US
Mailing Address - Phone:808-886-0600
Mailing Address - Fax:
Practice Address - Street 1:64-957 MAMAMLAHOA HWY
Practice Address - Street 2:SUITE 403
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96738-5810
Practice Address - Country:US
Practice Address - Phone:808-769-2263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1272171100000X
HI10238225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171100000XOther Service ProvidersAcupuncturist