Provider Demographics
NPI:1043234644
Name:TANGUILIG RUDY, CHERYL LYNN (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL LYNN
Middle Name:
Last Name:TANGUILIG RUDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST
Mailing Address - Street 2:SUITE 760
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1001
Mailing Address - Country:US
Mailing Address - Phone:808-947-5606
Mailing Address - Fax:808-948-5805
Practice Address - Street 1:1319 PUNAHOU ST
Practice Address - Street 2:SUITE 760
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1001
Practice Address - Country:US
Practice Address - Phone:808-947-5606
Practice Address - Fax:808-947-5805
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD8573207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI078209-01Medicaid
HICZ612ZMedicare UPIN
HI078209-01Medicaid