Provider Demographics
NPI:1912130329
Name:CHIBA, MARIKO (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARIKO
Middle Name:
Last Name:CHIBA
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 1:2575 KUHIO AVE APT 1802
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-2717
Mailing Address - Country:US
Mailing Address - Phone:808-351-7218
Mailing Address - Fax:
Practice Address - Street 1:725 KAPIOLANI BLVD STE C202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6023
Practice Address - Country:US
Practice Address - Phone:808-596-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT 10428174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist