Provider Demographics
NPI:1750699203
Name:MOSS, RUTH (LAC)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:MOSS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 ALAE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2507
Mailing Address - Country:US
Mailing Address - Phone:808-969-3989
Mailing Address - Fax:808-495-0227
Practice Address - Street 1:64 KEAWE ST STE 303
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2486
Practice Address - Country:US
Practice Address - Phone:808-969-3989
Practice Address - Fax:808-495-0227
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-17
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIACU1054171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist