Provider Demographics
NPI:1831693761
Name:BUMANGLAG, JERWIN R
Entity type:Individual
Prefix:
First Name:JERWIN
Middle Name:R
Last Name:BUMANGLAG
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 1:2017 KAUMUALII ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4047
Mailing Address - Country:US
Mailing Address - Phone:808-498-8791
Mailing Address - Fax:
Practice Address - Street 1:2017 KAUMUALII ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4047
Practice Address - Country:US
Practice Address - Phone:808-498-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-23
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies