Provider Demographics
NPI:1013584408
Name:LAFORGA, JENELYN
Entity Type:Individual
Prefix:
First Name:JENELYN
Middle Name:
Last Name:LAFORGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-502 PILIMAI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1627
Mailing Address - Country:US
Mailing Address - Phone:808-678-8446
Mailing Address - Fax:
Practice Address - Street 1:94-502 PILIMAI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1627
Practice Address - Country:US
Practice Address - Phone:808-678-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-05
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI825573Medicaid