Provider Demographics
NPI:1417055583
Name:LOSBANOS, ALFRED S (PT)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:S
Last Name:LOSBANOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BUDDY
Other - Middle Name:
Other - Last Name:LOSBANOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:56-565 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-2202
Mailing Address - Country:US
Mailing Address - Phone:808-293-9885
Mailing Address - Fax:808-293-1999
Practice Address - Street 1:56-565 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2202
Practice Address - Country:US
Practice Address - Phone:808-293-9885
Practice Address - Fax:808-293-1999
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT 1401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIZ1673OtherMDX HAWAII
ID558223Medicaid
HI0000246801OtherHMSA (BC/BS)
ID558223Medicaid