Provider Demographics
NPI:1619366796
Name:MABIOG, GERRLYN ALEXIS EGALIN
Entity Type:Individual
Prefix:
First Name:GERRLYN ALEXIS
Middle Name:EGALIN
Last Name:MABIOG
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 1:5419 KUAPAPA ST
Mailing Address - Street 2:P.O BOX 1620
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-2237
Mailing Address - Country:US
Mailing Address - Phone:808-721-3194
Mailing Address - Fax:
Practice Address - Street 1:210 WARD AVE
Practice Address - Street 2:SUITE 219B
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4008
Practice Address - Country:US
Practice Address - Phone:808-585-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst