Provider Demographics
NPI:1407970965
Name:CADIZ, CONCHITA (LMT)
Entity Type:Individual
Prefix:MS
First Name:CONCHITA
Middle Name:
Last Name:CADIZ
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 1:92-338 AKAULA ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1107
Mailing Address - Country:US
Mailing Address - Phone:808-672-9809
Mailing Address - Fax:808-672-5049
Practice Address - Street 1:92-338 AKAULA ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1107
Practice Address - Country:US
Practice Address - Phone:808-672-9809
Practice Address - Fax:808-672-5049
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 2306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist