Provider Demographics
NPI:1629696414
Name:OLIVOVA, LUCIE (LMT)
Entity Type:Individual
Prefix:
First Name:LUCIE
Middle Name:
Last Name:OLIVOVA
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 1:2430 OKA ST STE B
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5332
Mailing Address - Country:US
Mailing Address - Phone:808-828-0030
Mailing Address - Fax:808-977-7769
Practice Address - Street 1:2430 OKA ST STE B
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5332
Practice Address - Country:US
Practice Address - Phone:808-828-0030
Practice Address - Fax:808-977-7769
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT9632225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMAT9632OtherSTATE OF HAWAII DCCA