Provider Demographics
NPI:1619103900
Name:PREMKAMAL SPAS LLC
Entity Type:Organization
Organization Name:PREMKAMAL SPAS LLC
Other - Org Name:LOTUS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BANTHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-334-0445
Mailing Address - Street 1:75-5852 ALII DR
Mailing Address - Street 2:166
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1310
Mailing Address - Country:US
Mailing Address - Phone:808-334-0445
Mailing Address - Fax:
Practice Address - Street 1:75-5852 ALII DR
Practice Address - Street 2:166
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1310
Practice Address - Country:US
Practice Address - Phone:808-334-0445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty