Provider Demographics
NPI:1760052641
Name:DOMINGO, JERMY BOLOSAN
Entity Type:Individual
Prefix:
First Name:JERMY
Middle Name:BOLOSAN
Last Name:DOMINGO
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 1:1003 BISHOP STREET
Mailing Address - Street 2:PAUAHI TOWER, SUITE 1810
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-791-7831
Mailing Address - Fax:
Practice Address - Street 1:1003 BISHOP STREET
Practice Address - Street 2:PAUAHI TOWER, SUITE 1810
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-791-7831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator