MEDICARE: KRYSTINE ANN WAGGONER CABRERA

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	104100000X	Social Worker	LSW-3425-0	HI

General Provider Information

NPI Number	:	1902731698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRYSTINE ANN WAGGONER CABRERA

Provider Business Mailing Address
First Line	:	620 MCCULLY ST APT 402
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96826-3939
Country	:	US
Telephone Number	:	425-230-7317
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 MCCULLY ST APT 402
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96826-3939
Country	:	US
Telephone Number	:	425-230-7317
Fax Number	:

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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