Provider Demographics
NPI:1477797934
Name:UBILAS, RENELY LAZO
Entity Type:Individual
Prefix:MRS
First Name:RENELY
Middle Name:LAZO
Last Name:UBILAS
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 1:563 S KAMEHAMEHA AVE
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1945
Mailing Address - Country:US
Mailing Address - Phone:808-871-7739
Mailing Address - Fax:808-871-7739
Practice Address - Street 1:563 S KAMEHAMEHA AVE
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1945
Practice Address - Country:US
Practice Address - Phone:808-871-7739
Practice Address - Fax:808-871-7739
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI020900995376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51094201Medicaid