Provider Demographics
NPI:1659969806
Name:HIMALAYA, JONATHAN (LMT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:HIMALAYA
Suffix:
Gender:M
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:PO BOX 10732
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96721-5732
Mailing Address - Country:US
Mailing Address - Phone:808-756-6344
Mailing Address - Fax:
Practice Address - Street 1:65-1241 POMAIKAI PL APT 7
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-7311
Practice Address - Country:US
Practice Address - Phone:808-896-9188
Practice Address - Fax:808-315-7989
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist