Provider Demographics
NPI:1598538936
Name:NAGUM, NATHAN RAGODOS
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:RAGODOS
Last Name:NAGUM
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 1:550 KUNEHI ST APT 206
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2069
Mailing Address - Country:US
Mailing Address - Phone:808-674-6641
Mailing Address - Fax:
Practice Address - Street 1:94-119 POOLAU WAY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5807
Practice Address - Country:US
Practice Address - Phone:808-517-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-23-309010106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician