Healthcare Provider Details

I. General information

NPI: 1568849586
Provider Name (Legal Business Name): MR. BONY RAGUIRAG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1001 AWAIKI ST
WAIPAHU HI
96797-3218
US

IV. Provider business mailing address

94-1001 AWAIKI ST
WAIPAHU HI
96797-3218
US

V. Phone/Fax

Practice location:
  • Phone: 808-741-0271
  • Fax: 808-353-3611
Mailing address:
  • Phone: 808-741-0271
  • Fax: 808-353-3611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH01028739
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: