Provider Demographics
NPI:1730666165
Name:ZEVALLOS, VANESSA (LMT)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:ZEVALLOS
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 1:908 PROSPECT ST APT 4
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3424
Mailing Address - Country:US
Mailing Address - Phone:808-561-4432
Mailing Address - Fax:
Practice Address - Street 1:3221 WAIALAE AVE STE 360
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5849
Practice Address - Country:US
Practice Address - Phone:808-561-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12661225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist