Provider Demographics
NPI:1215402003
Name:CORPUZ, SHARLENE
Entity Type:Individual
Prefix:
First Name:SHARLENE
Middle Name:
Last Name:CORPUZ
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 1:94-053 POAILANI CIR
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3207
Mailing Address - Country:US
Mailing Address - Phone:808-221-7706
Mailing Address - Fax:
Practice Address - Street 1:94-053 POAILANI CIR
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3207
Practice Address - Country:US
Practice Address - Phone:808-221-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty