Healthcare Provider Details

I. General information

NPI: 1912810979
Provider Name (Legal Business Name): JULIUS BUMANGLAG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1367 MALIKO ST
EWA BEACH HI
96706-1809
US

IV. Provider business mailing address

91-1367 MALIKO ST
EWA BEACH HI
96706-1809
US

V. Phone/Fax

Practice location:
  • Phone: 808-391-6810
  • Fax:
Mailing address:
  • Phone: 808-391-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHI000019084E
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: