Provider Demographics
NPI:1508191693
Name:VIDINHA, LOUELLA KAHEALANI (LMT)
Entity Type:Individual
Prefix:
First Name:LOUELLA
Middle Name:KAHEALANI
Last Name:VIDINHA
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 1:98-027 HEKAHA ST
Mailing Address - Street 2:BLDG #3 SUITE #21
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4910
Mailing Address - Country:US
Mailing Address - Phone:808-488-2221
Mailing Address - Fax:808-488-2221
Practice Address - Street 1:98-027 HEKAHA ST
Practice Address - Street 2:BLDG #3 SUITE #21
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4910
Practice Address - Country:US
Practice Address - Phone:808-488-2221
Practice Address - Fax:808-488-2221
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT3273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist