Provider Demographics
NPI:1558028464
Name:MANUEL, JAMAICA LAGUNA
Entity Type:Individual
Prefix:MISS
First Name:JAMAICA
Middle Name:LAGUNA
Last Name:MANUEL
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 1:91-822 LIPAKI PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2922
Mailing Address - Country:US
Mailing Address - Phone:808-953-7174
Mailing Address - Fax:
Practice Address - Street 1:91-822 LIPAKI PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2922
Practice Address - Country:US
Practice Address - Phone:808-953-7174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-27
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care