Provider Demographics
NPI:1558091520
Name:FERRERO-EGLORIA, CONNIE JO (LMT)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JO
Last Name:FERRERO-EGLORIA
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 1:94-1052 NALII ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3346
Mailing Address - Country:US
Mailing Address - Phone:808-783-5359
Mailing Address - Fax:
Practice Address - Street 1:458 MANAWAI ST
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-4604
Practice Address - Country:US
Practice Address - Phone:808-783-5359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11956225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty