Provider Demographics
NPI:1174191985
Name:PASCUAL, MANUEL LAGUNA JR
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:LAGUNA
Last Name:PASCUAL
Suffix:JR
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 1:98-211 PALI MOMI ST STE 707
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4339
Mailing Address - Country:US
Mailing Address - Phone:808-450-9250
Mailing Address - Fax:
Practice Address - Street 1:98-211 PALI MOMI ST STE 707
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4339
Practice Address - Country:US
Practice Address - Phone:808-450-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-16
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist