Provider Demographics
NPI:1710465042
Name:ADVANCED MASSAGE WEST OAHU INC.
Entity Type:Organization
Organization Name:ADVANCED MASSAGE WEST OAHU INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:TANJOCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:808-729-8391
Mailing Address - Street 1:91-2047 KAIOLI ST APT 2602
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6159
Mailing Address - Country:US
Mailing Address - Phone:808-277-6201
Mailing Address - Fax:808-443-0813
Practice Address - Street 1:91-2047 KAIOLI ST APT 2602
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6159
Practice Address - Country:US
Practice Address - Phone:808-277-6201
Practice Address - Fax:808-443-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-11688261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation