Provider Demographics
NPI:1376120717
Name:UBONGEN, JAIME BRAGADO JR
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:BRAGADO
Last Name:UBONGEN
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 1:861 WAIOLI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1626
Mailing Address - Country:US
Mailing Address - Phone:808-741-6075
Mailing Address - Fax:
Practice Address - Street 1:861 WAIOLI ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1626
Practice Address - Country:US
Practice Address - Phone:808-741-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist