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General NPI Number Information
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NPI Number | 1902758923
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Entity Type | Individual
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Provider Name | JAYDAN CARL LAZO PAYUMO
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Gender | Male
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Dates
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Enumeration Date | 02/11/2026
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Last Update Date | 02/11/2026
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Provider Practice Location Address
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Address Line | 91-1027 SHANGRILA ST BLDG 1867
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City | KAPOLEI
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State | HI
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Zip | 96707-2101
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Country | US
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Telephone | 808-674-9595
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Fax | 808-674-9696
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Provider Business Mailing Address
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Address Line | 91-1098 HAMANA ST APT E
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City | EWA BEACH
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State | HI
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Zip | 96706-4114
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Country | US
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Telephone | 808-220-6788
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State | HI
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