Provider Demographics
NPI:1912021940
Name:CAMACAYLAN, DISA GAY B
Entity Type:Individual
Prefix:
First Name:DISA GAY
Middle Name:B
Last Name:CAMACAYLAN
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 1:65-1230 MAMALAHOA HWY
Mailing Address - Street 2:SUITE E11
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8318
Mailing Address - Country:US
Mailing Address - Phone:808-885-7131
Mailing Address - Fax:
Practice Address - Street 1:65-1230 MAMALAHOA HWY
Practice Address - Street 2:SUITE E11
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8318
Practice Address - Country:US
Practice Address - Phone:808-885-7131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008661A171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor