Provider Demographics
NPI:1336410794
Name:MAUI MASSAGE & WELLNESS LLC
Entity Type:Organization
Organization Name:MAUI MASSAGE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:PRADO
Authorized Official - Suffix:
Authorized Official - Credentials:LMAT
Authorized Official - Phone:808-669-4500
Mailing Address - Street 1:3636 LOWER HONOAPIILANI RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-5916
Mailing Address - Country:US
Mailing Address - Phone:808-669-4500
Mailing Address - Fax:
Practice Address - Street 1:3636 LOWER HONOAPIILANI RD STE 3
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-5916
Practice Address - Country:US
Practice Address - Phone:808-669-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAE2724172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty