Provider Demographics
NPI:1831661883
Name:MIZUGUCHI, JANELLE (LMT)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:MIZUGUCHI
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 1:16 2055 JEWEL DRIVE
Mailing Address - Street 2:#81587
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778
Mailing Address - Country:US
Mailing Address - Phone:808-982-4086
Mailing Address - Fax:
Practice Address - Street 1:16 2055 JEWEL DRIVE
Practice Address - Street 2:#81587
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778
Practice Address - Country:US
Practice Address - Phone:808-756-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI13948OtherSTATE OF HAWAII DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS