Provider Demographics
NPI:1184091043
Name:SOULISTIC HOLISTICS HAWAII LLC
Entity type:Organization
Organization Name:SOULISTIC HOLISTICS HAWAII LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SORAYA
Authorized Official - Middle Name:FARIS
Authorized Official - Last Name:APPLEGATE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:808-721-3083
Mailing Address - Street 1:46-063 EMEPELA PL
Mailing Address - Street 2:V/100
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3947
Mailing Address - Country:US
Mailing Address - Phone:808-721-3083
Mailing Address - Fax:
Practice Address - Street 1:46-024 KAMEHAMEHA HWY
Practice Address - Street 2:#210
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3714
Practice Address - Country:US
Practice Address - Phone:808-721-3083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1133171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty