Provider Demographics
NPI:1356007421
Name:MIGUEL, MARILYN
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:MIGUEL
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 1:91-1101 KAUNOLU ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2824
Mailing Address - Country:US
Mailing Address - Phone:808-256-8748
Mailing Address - Fax:808-888-4857
Practice Address - Street 1:91-1101 KAUNOLU ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2824
Practice Address - Country:US
Practice Address - Phone:808-256-8748
Practice Address - Fax:808-888-4857
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI598287174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist