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General NPI Number Information
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NPI Number | 1063272573
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Entity Type | Individual
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Provider Name | BRANDON AVERY AGPAOA-THOMPSON
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Gender | Male
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Dates
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Enumeration Date | 03/21/2024
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 270 HOOKAHI STREET # 210
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City | WAILUKU
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State | HI
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Zip | 96793
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Country | US
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Telephone | 808-344-8527
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Fax |
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Provider Business Mailing Address
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Address Line | 497 S OAHU ST
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City | KAHULUI
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State | HI
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Zip | 96732-2713
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Country | US
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Telephone | 808-344-8527
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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