Provider Demographics
NPI:1073366894
Name:ABEGONIA, GARY MABAHIN (REGISTER NURSE)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:MABAHIN
Last Name:ABEGONIA
Suffix:
Gender:M
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92-831 MAKAKILO DRIVE
Mailing Address - Street 2:APT 14
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-381-7721
Mailing Address - Fax:
Practice Address - Street 1:94-216 FARRINGTON HIIGHWAY
Practice Address - Street 2:SUITE B102
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-381-7721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI89236163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse