Individual
GABRIELLA MATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
65-1235 OPELU RD, KAMUELA, HI 96743
(808) 443-3180
Mailing address
PO BOX 1102, KAMUELA, HI 96743
(808) 443-3180
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT-6002
HI
Other
Enumeration date
10/28/2015
Last updated
10/28/2015
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