Provider Demographics
NPI:1508342585
Name:UNIVERSAL SOUL SERVICE INC
Entity Type:Organization
Organization Name:UNIVERSAL SOUL SERVICE INC
Other - Org Name:MASTER SHA TAO CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMBUENO
Authorized Official - Suffix:JR
Authorized Official - Credentials:BBA
Authorized Official - Phone:808-551-2246
Mailing Address - Street 1:885 QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5289
Mailing Address - Country:US
Mailing Address - Phone:808-988-8090
Mailing Address - Fax:
Practice Address - Street 1:885 QUEEN ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5289
Practice Address - Country:US
Practice Address - Phone:808-988-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty