Provider Demographics
NPI:1265205165
Name:ANLOAGUE, PAUL ANDRADE
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDRADE
Last Name:ANLOAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1111 HOOMAKOA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3723
Mailing Address - Country:US
Mailing Address - Phone:808-364-8806
Mailing Address - Fax:808-312-4733
Practice Address - Street 1:94-1111 HOOMAKOA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3723
Practice Address - Country:US
Practice Address - Phone:808-364-8806
Practice Address - Fax:808-312-4733
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIH01261239343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)