Provider Demographics
NPI:1609422062
Name:MASUDA, TRAVIS SATORU
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:SATORU
Last Name:MASUDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1286 ALEWA DR APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-7505
Mailing Address - Country:US
Mailing Address - Phone:808-354-4563
Mailing Address - Fax:
Practice Address - Street 1:1286 ALEWA DR APT A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-7505
Practice Address - Country:US
Practice Address - Phone:808-354-4563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist