Provider Demographics
NPI:1114313038
Name:LAGBAS, MYCHAEL BLAKE
Entity Type:Individual
Prefix:
First Name:MYCHAEL
Middle Name:BLAKE
Last Name:LAGBAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1655 MAKALOA ST APT 1010
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3912
Mailing Address - Country:US
Mailing Address - Phone:808-276-3808
Mailing Address - Fax:
Practice Address - Street 1:1655 MAKALOA ST APT 1010
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3912
Practice Address - Country:US
Practice Address - Phone:808-276-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program