Provider Demographics
NPI:1942934625
Name:IRIZARRY, KANDI (LMT)
Entity Type:Individual
Prefix:
First Name:KANDI
Middle Name:
Last Name:IRIZARRY
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 1:1305 KIPAIPAI ST APT 24C
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2591
Mailing Address - Country:US
Mailing Address - Phone:808-383-8792
Mailing Address - Fax:
Practice Address - Street 1:1305 KIPAIPAI ST APT 24C
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2591
Practice Address - Country:US
Practice Address - Phone:808-383-8792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-17130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist