Provider Demographics
NPI:1194358804
Name:SERAPION, JOBELLE VELASQUEZ
Entity Type:Individual
Prefix:
First Name:JOBELLE
Middle Name:VELASQUEZ
Last Name:SERAPION
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 1:86-409B HALONA RD
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2807
Mailing Address - Country:US
Mailing Address - Phone:808-398-4488
Mailing Address - Fax:
Practice Address - Street 1:86-409B HALONA RD
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2807
Practice Address - Country:US
Practice Address - Phone:808-398-4488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI88453163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics