Provider Demographics
NPI:1356627103
Name:BAYOT, EMMANUELISA LUZ
Entity Type:Individual
Prefix:MS
First Name:EMMANUELISA LUZ
Middle Name:
Last Name:BAYOT
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:EMMANUELISA
Other - Middle Name:LUZ
Other - Last Name:BAYOT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:91-1020 POHAHAWAI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-772-4551
Mailing Address - Fax:808-772-4551
Practice Address - Street 1:91-1020 POHAHAWAI ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-772-4551
Practice Address - Fax:808-772-4551
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies