Provider Demographics
NPI:1225501125
Name:LANE, HIROMI (MAT-12285)
Entity Type:Individual
Prefix:MRS
First Name:HIROMI
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MAT-12285
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 KALAKAUA AVE STE 1011
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1528
Mailing Address - Country:US
Mailing Address - Phone:808-291-0170
Mailing Address - Fax:
Practice Address - Street 1:1833 KALAKAUA AVE STE 1011
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1528
Practice Address - Country:US
Practice Address - Phone:808-291-0170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-12285225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist