Healthcare Provider Details

I. General information

NPI: 1376365296
Provider Name (Legal Business Name): CIENNA MARIE GALICINAO CORPUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PAUAHI ST STE 208
HILO HI
96720-3044
US

IV. Provider business mailing address

28-3008 ANDRADE RD
PEPEEKEO HI
96783-8403
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-1935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: