Provider Demographics
NPI:1497103444
Name:CUPPLES, CASSANDRA LEA (LAC, MSTOM)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LEA
Last Name:CUPPLES
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:NAALEHU
Mailing Address - State:HI
Mailing Address - Zip Code:96772-0525
Mailing Address - Country:US
Mailing Address - Phone:808-209-9977
Mailing Address - Fax:
Practice Address - Street 1:92-8961 LOTUS BLOSSOM LANE
Practice Address - Street 2:
Practice Address - City:OCEANVIEW
Practice Address - State:HI
Practice Address - Zip Code:96704
Practice Address - Country:US
Practice Address - Phone:808-209-9977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU 1160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist