Provider Demographics
NPI:1790495588
Name:PAGARAGAN, MANUEL F JR
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:F
Last Name:PAGARAGAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MANU
Other - Middle Name:F
Other - Last Name:PAGARAGAN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MANU
Mailing Address - Street 1:2516 ROSE ST APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-5606
Mailing Address - Country:US
Mailing Address - Phone:808-256-4162
Mailing Address - Fax:
Practice Address - Street 1:1330 ALA MOANA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4262
Practice Address - Country:US
Practice Address - Phone:808-585-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-21-158597106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIRBT-21-158597OtherBACB