Provider Demographics
NPI:1750176079
Name:INOCENCIO, LAURA UMAYAM (NOT APPLICABLE)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:UMAYAM
Last Name:INOCENCIO
Suffix:
Gender:
Credentials:NOT APPLICABLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-656 KILINAHE ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2716
Mailing Address - Country:US
Mailing Address - Phone:808-722-2760
Mailing Address - Fax:808-200-5144
Practice Address - Street 1:91-656 KILINAHE ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2716
Practice Address - Country:US
Practice Address - Phone:808-722-2760
Practice Address - Fax:808-200-5144
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-180039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist