Provider Demographics
NPI:1952738726
Name:ROLDAN, DONNA BARRACA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:BARRACA
Last Name:ROLDAN
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 1:94-366 PUPUPANI STREET
Mailing Address - Street 2:SUITE 209B
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797
Mailing Address - Country:US
Mailing Address - Phone:808-597-6103
Mailing Address - Fax:808-680-0015
Practice Address - Street 1:94-366 PUPUPANI STREET
Practice Address - Street 2:SUITE 209B
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-597-6103
Practice Address - Fax:808-680-0015
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12108225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist