Provider Demographics
NPI:1639672942
Name:LAURONAL, KRISTIAN FAYE AGGASID
Entity Type:Individual
Prefix:MRS
First Name:KRISTIAN FAYE
Middle Name:AGGASID
Last Name:LAURONAL
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 1:601 KAMOKILA BLVD STE 355
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2035
Mailing Address - Country:US
Mailing Address - Phone:808-692-7700
Mailing Address - Fax:
Practice Address - Street 1:601 KAMOKILA BLVD STE 355
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2035
Practice Address - Country:US
Practice Address - Phone:808-692-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker