Provider Demographics
NPI:1245641133
Name:SAGAYAGA, JOSEPHINE (CNA)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:SAGAYAGA
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 KALAUIPO ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2033
Mailing Address - Country:US
Mailing Address - Phone:808-455-8776
Mailing Address - Fax:808-455-8776
Practice Address - Street 1:1483 KALAUIPO ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2033
Practice Address - Country:US
Practice Address - Phone:808-455-8776
Practice Address - Fax:808-455-8776
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI020402656171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator