Healthcare Provider Details

I. General information

NPI: 1932241288
Provider Name (Legal Business Name): BRENDA ULEP BUMANGLAG LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-0080
  • Fax: 808-433-0391
Mailing address:
  • Phone: 808-433-0080
  • Fax: 808-433-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1341
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: