MEDICARE: LEI DEN JOY TUGAOEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	89702	HI

General Provider Information

NPI Number	:	1063076222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEI DEN JOY TUGAOEN

Provider Business Mailing Address
First Line	:	91-1156 PIIPII ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	91-1156 PIIPII ST
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-1834
Country	:	US
Telephone Number	:	808-391-6404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	04/23/2019

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Directions to “ LEI DEN JOY TUGAOEN ” Practice Location

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