Provider Demographics
NPI:1447403704
Name:MATUTINO, MELISSA ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANN
Last Name:MATUTINO
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 1:92-1148 PANANA ST APT 239
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1466
Mailing Address - Country:US
Mailing Address - Phone:808-688-4135
Mailing Address - Fax:808-455-4442
Practice Address - Street 1:803 KAMEHAMEHA HWY STE 416F
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2638
Practice Address - Country:US
Practice Address - Phone:808-455-4448
Practice Address - Fax:808-455-4442
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI110001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist