Healthcare Provider Details

I. General information

NPI: 1265133888
Provider Name (Legal Business Name): KRYSTLE-MAE AGAS BARROGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1159 KAMAKANA ST APT 923
EWA BEACH HI
96706-5801
US

IV. Provider business mailing address

91-1159 KAMAKANA ST APT 923
EWA BEACH HI
96706-5801
US

V. Phone/Fax

Practice location:
  • Phone: 808-652-1128
  • Fax:
Mailing address:
  • Phone: 808-652-1128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN-80861
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: