Provider Demographics
NPI:1700423621
Name:ISIDRO, GRACE MARIE SAJOR (LMT)
Entity Type:Individual
Prefix:MRS
First Name:GRACE MARIE
Middle Name:SAJOR
Last Name:ISIDRO
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 1:94-1157 AWAIKI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3224
Mailing Address - Country:US
Mailing Address - Phone:808-292-1894
Mailing Address - Fax:
Practice Address - Street 1:338 KAMOKILA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2055
Practice Address - Country:US
Practice Address - Phone:808-674-9998
Practice Address - Fax:808-674-9877
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist