Provider Demographics
NPI:1962382291
Name:VILLAGOMEZ, MAELY EMELLE
Entity type:Individual
Prefix:
First Name:MAELY EMELLE
Middle Name:
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2474 KAPIOLANI BLVD APT 1603
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-4631
Mailing Address - Country:US
Mailing Address - Phone:808-521-3617
Mailing Address - Fax:808-537-1578
Practice Address - Street 1:2474 KAPIOLANI BLVD APT 1603
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-4631
Practice Address - Country:US
Practice Address - Phone:808-521-3617
Practice Address - Fax:808-537-1578
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17876225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist