Provider Demographics
NPI:1881453413
Name:BAGUIO-LARENA, EDELUISA
Entity type:Individual
Prefix:
First Name:EDELUISA
Middle Name:
Last Name:BAGUIO-LARENA
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 1:44 KA IKENA LOOP
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-4170
Mailing Address - Country:US
Mailing Address - Phone:808-281-5691
Mailing Address - Fax:
Practice Address - Street 1:44 KA IKENA LOOP
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-4170
Practice Address - Country:US
Practice Address - Phone:808-281-5691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician