Provider Demographics
NPI:1659821759
Name:CORPUZ, NOEL
Entity Type:Individual
Prefix:MR
First Name:NOEL
Middle Name:
Last Name:CORPUZ
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 1:599 FARRINGTON HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2028
Mailing Address - Country:US
Mailing Address - Phone:808-674-1142
Mailing Address - Fax:
Practice Address - Street 1:599 FARRINGTON HWY STE 102
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2028
Practice Address - Country:US
Practice Address - Phone:808-674-1142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-5587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist