Provider Demographics
NPI:1265898563
Name:RIEL, ISAIAS KINOIKAIKA AMBY (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ISAIAS
Middle Name:KINOIKAIKA AMBY
Last Name:RIEL
Suffix:
Gender:M
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 631680
Mailing Address - Street 2:
Mailing Address - City:LANAI CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96763-1308
Mailing Address - Country:US
Mailing Address - Phone:808-870-6490
Mailing Address - Fax:
Practice Address - Street 1:436 ILIAHI STREET
Practice Address - Street 2:
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763-1308
Practice Address - Country:US
Practice Address - Phone:808-870-6490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT7945173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist