Provider Demographics
NPI:1922626373
Name:AZEKA, RIANE (LMT)
Entity Type:Individual
Prefix:
First Name:RIANE
Middle Name:
Last Name:AZEKA
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 1:2936 LOWER KULA RD
Mailing Address - Street 2:
Mailing Address - City:KULA
Mailing Address - State:HI
Mailing Address - Zip Code:96790-8726
Mailing Address - Country:US
Mailing Address - Phone:808-341-5995
Mailing Address - Fax:
Practice Address - Street 1:2940 LOWER KULA RD
Practice Address - Street 2:
Practice Address - City:KULA
Practice Address - State:HI
Practice Address - Zip Code:96790-8726
Practice Address - Country:US
Practice Address - Phone:808-341-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-13884225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty