Individual
BLAINE KK CACERES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED MASSAGE THE
Contact information
Practice address
475 AWA ST, HILO, HI 96720-5809
(808) 960-9941
Mailing address
475 AWA ST, HILO, HI 96720-5809
(808) 960-9941
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
15734
HI
Other
Enumeration date
08/21/2019
Last updated
08/21/2019
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