Healthcare Provider Details

I. General information

NPI: 1922812015
Provider Name (Legal Business Name): MANNYCEL A DELA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1508 WAIPAHU ST
WAIPAHU HI
96797-3559
US

IV. Provider business mailing address

94-1508 WAIPAHU ST
WAIPAHU HI
96797-3559
US

V. Phone/Fax

Practice location:
  • Phone: 808-387-7890
  • Fax:
Mailing address:
  • Phone: 808-387-7890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberGE-076-813-1584-01
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: