Provider Demographics
NPI:1932666724
Name:WUNDERLICH, XIMENA E (LMT)
Entity Type:Individual
Prefix:
First Name:XIMENA
Middle Name:E
Last Name:WUNDERLICH
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 1:66-590 KAMEHAMEHA HWY STE 2F
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1484
Mailing Address - Country:US
Mailing Address - Phone:808-260-7210
Mailing Address - Fax:808-564-0050
Practice Address - Street 1:66-590 KAMEHAMEHA HWY STE 2F
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1484
Practice Address - Country:US
Practice Address - Phone:808-260-7210
Practice Address - Fax:808-564-0050
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist