Provider Demographics
NPI:1134512718
Name:TUBANA, CORAZON
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:
Last Name:TUBANA
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 1:94-541 LOAA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1511
Mailing Address - Country:US
Mailing Address - Phone:808-228-2405
Mailing Address - Fax:
Practice Address - Street 1:94-541 LOAA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1511
Practice Address - Country:US
Practice Address - Phone:808-228-2405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide