Provider Demographics
NPI:1508951153
Name:BOGGS, MINNIE EIKO (PHD)
Entity Type:Individual
Prefix:DR
First Name:MINNIE
Middle Name:EIKO
Last Name:BOGGS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3266 ALANI DRIVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1403
Mailing Address - Country:US
Mailing Address - Phone:808-988-0000
Mailing Address - Fax:808-988-0000
Practice Address - Street 1:3266 ALANI DRIVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1403
Practice Address - Country:US
Practice Address - Phone:808-988-0000
Practice Address - Fax:808-988-0000
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 114103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB6091-9OtherHMSA PROVIDER NUMBER
HI0000TCBNCMedicare ID - Type Unspecified