Provider Demographics
NPI:1366957532
Name:CUMMINGS, TIFFANY HAUOLI (MAT BEO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:HAUOLI
Last Name:CUMMINGS
Suffix:
Gender:F
Credentials:MAT BEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1768 PALOLO AVE APT G
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2593
Mailing Address - Country:US
Mailing Address - Phone:808-358-1046
Mailing Address - Fax:
Practice Address - Street 1:1137 11TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2461
Practice Address - Country:US
Practice Address - Phone:808-358-1046
Practice Address - Fax:808-358-1046
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-13355225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist