Provider Demographics
NPI:1568849586
Name:RAGUIRAG, BONY
Entity Type:Individual
Prefix:MR
First Name:BONY
Middle Name:
Last Name:RAGUIRAG
Suffix:
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 1:94-1001 AWAIKI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3218
Mailing Address - Country:US
Mailing Address - Phone:808-741-0271
Mailing Address - Fax:808-353-3611
Practice Address - Street 1:94-1001 AWAIKI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3218
Practice Address - Country:US
Practice Address - Phone:808-741-0271
Practice Address - Fax:808-353-3611
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH01028739172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPUC-307COtherPUC LICENSE
HIH01028739OtherHI LICENSE