Provider Demographics
NPI:1871016790
Name:MINCHEVA, VESELA IVANOVA (LMT)
Entity Type:Individual
Prefix:
First Name:VESELA
Middle Name:IVANOVA
Last Name:MINCHEVA
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:PO BOX 5366
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-5366
Mailing Address - Country:US
Mailing Address - Phone:408-469-3759
Mailing Address - Fax:
Practice Address - Street 1:74-5583 LUHIA ST
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3624
Practice Address - Country:US
Practice Address - Phone:408-469-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-15257225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist