Provider Demographics
NPI:1609099415
Name:MOYA, JUANA (LMT)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:
Last Name:MOYA
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 1:77-6425 KUAKINI HWY
Mailing Address - Street 2:SUITE C-2, #64
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3213
Mailing Address - Country:US
Mailing Address - Phone:808-322-6871
Mailing Address - Fax:
Practice Address - Street 1:78-7006 WAILUA RD
Practice Address - Street 2:
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-322-6871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8947225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist