Healthcare Provider Details

I. General information

NPI: 1902438740
Provider Name (Legal Business Name): BETSY CABINGABANG FA'ASU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-520 KUHIALOKO ST
EWA BEACH HI
96706-4518
US

IV. Provider business mailing address

91-520 KUHIALOKO ST
EWA BEACH HI
96706-4518
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-3663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number96490
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: