Provider Demographics
NPI:1891100319
Name:GANGCUANGCO, LOUIE MAR ALVIZ (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:LOUIE MAR
Middle Name:ALVIZ
Last Name:GANGCUANGCO
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 ILALO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5525
Mailing Address - Country:US
Mailing Address - Phone:808-692-1357
Mailing Address - Fax:
Practice Address - Street 1:651 ILALO ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-5525
Practice Address - Country:US
Practice Address - Phone:808-692-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HIMD-22727-02083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program