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General NPI Number Information
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NPI Number | 1346647294
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Entity Type | Individual
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Provider Name | MARIO KE'OLA MACAGBA B.S.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2014
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 875 WAIMANU ST
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City | HONOLULU
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State | HI
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Zip | 96813
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Country | US
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Telephone | 808-748-9810
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Fax |
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Provider Business Mailing Address
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Address Line | 95582 KIPAPA DRIVE
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City | MILILANI
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State | HI
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Zip | 96789
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Country | US
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Telephone | 808-748-9810
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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