Provider Demographics
NPI:1457679326
Name:DAVIS, ERICA GIAO
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:GIAO
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68-3557 MALINA ST
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-5353
Mailing Address - Country:US
Mailing Address - Phone:808-371-4877
Mailing Address - Fax:
Practice Address - Street 1:68-1845 WAIKOLOA RD
Practice Address - Street 2:UNIT 201 B
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738-5584
Practice Address - Country:US
Practice Address - Phone:808-443-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI6473225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist