Most Relevant Information
Provider Data
| NPI Number: | 1003463373 |
| Provider Name: | BLAINE KK CACERES LICENSED MASSAGE THE |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 15734 |
Most Important Dates
| Enumeration Date: | 08/21/2019 |
| Last Updated: | 08/21/2019 |
Provider Practice Location
475 AWA ST
HILO
HI
967205809
Practice Location Phone/Fax
| Phone: | 8089609941 |
| Fax: |
Provider Mailing Location
475 AWA ST
HILO
HI
967205809
Provider Mailing Phone/Fax
| Phone: | 8089609941 |
| Fax: |