Healthcare Provider Details

I. General information

NPI: 1447907480
Provider Name (Legal Business Name): MAEGAN DIOQUINO FAGARAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 MILLER ST
HONOLULU HI
96813-2493
US

IV. Provider business mailing address

94-1075 HAALAU ST
WAIPAHU HI
96797-4540
US

V. Phone/Fax

Practice location:
  • Phone: 808-586-4997
  • Fax:
Mailing address:
  • Phone: 808-304-6659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH01437407
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: