Provider Demographics
NPI:1891396081
Name:ALCONCEL, JUVY RIVAD (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:JUVY
Middle Name:RIVAD
Last Name:ALCONCEL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
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 630284
Mailing Address - Street 2:
Mailing Address - City:LANAI CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96763-0284
Mailing Address - Country:US
Mailing Address - Phone:808-756-0238
Mailing Address - Fax:
Practice Address - Street 1:1382 LANAI AVENUE
Practice Address - Street 2:1382 LANAI AVENUE
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763
Practice Address - Country:US
Practice Address - Phone:808-756-0238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-14637225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist