Provider Demographics
NPI:1912574674
Name:CORPUZ, MARICEL
Entity Type:Individual
Prefix:
First Name:MARICEL
Middle Name:
Last Name:CORPUZ
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 1:94-972 LUMILOKE ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3962
Mailing Address - Country:US
Mailing Address - Phone:808-620-7014
Mailing Address - Fax:
Practice Address - Street 1:94-972 LUMILOKE ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3962
Practice Address - Country:US
Practice Address - Phone:808-620-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI040806171376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIHI040806171OtherNURSE AIDE LICENSE NUMBER