MEDICARE: DR. ANGELICA A. TAGABAN PSY.D., LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MHC-762	HI

General Provider Information

NPI Number	:	1265014773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELICA A. TAGABAN PSY.D., LMHC

Provider Business Mailing Address
First Line	:	94-542 MAHOE ST
Second Line	:
City	:	WAIPAHU
State	:	HI
Zip	:	96797-3731
Country	:	US
Telephone Number	:	808-729-4913
Fax Number	:

Provider Business Practice Location Address
First Line	:	98-030 HEKAHA ST STE 24
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-4911
Country	:	US
Telephone Number	:	808-729-4913
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2021
Last Update Date	:	04/23/2021

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