Provider Demographics
NPI:1629308317
Name:BROWN GUILLERMO, SHARON (LMT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BROWN GUILLERMO
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 1:75-5782 KUAKINI HWY
Mailing Address - Street 2:A TOUCH OF HEAVEN #3-B
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75-5782 KUAKINI HWY
Practice Address - Street 2:A TOUCH OF HEAVEN #3-B
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1746
Practice Address - Country:US
Practice Address - Phone:808-937-2711
Practice Address - Fax:808-329-1560
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-03
Last Update Date:2010-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 4281225700000X
HIMAE 1202225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist