Provider Demographics
NPI:1235780651
Name:PASCUA, LAURELL B C (LMT)
Entity Type:Individual
Prefix:
First Name:LAURELL
Middle Name:B C
Last Name:PASCUA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-199 HOAHELE PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5544
Mailing Address - Country:US
Mailing Address - Phone:808-674-0500
Mailing Address - Fax:808-674-0511
Practice Address - Street 1:1001 KAMOKILA BLVD STE 114
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2095
Practice Address - Country:US
Practice Address - Phone:808-674-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT16147225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist