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Individual

ROGER BACLA-AN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
94-216 FARRINGTON HWY STE 202, WAIPAHU, HI 96797-1900
(808) 600-9147
Mailing address
91-839 POHAKUPUNA RD, EWA BEACH, HI 96706-2545

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
13360
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
H00556480
DRIVERS LICENSE
HI
Enumeration date
09/08/2017
Last updated
09/08/2017
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