Provider Demographics
NPI:1982321014
Name:ANGUAY, TIAREMARIE KUUIPO
Entity Type:Individual
Prefix:
First Name:TIAREMARIE
Middle Name:KUUIPO
Last Name:ANGUAY
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 1:15-352 KAHAKAI BLVD
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-8909
Mailing Address - Country:US
Mailing Address - Phone:808-721-7613
Mailing Address - Fax:
Practice Address - Street 1:15-352 KAHAKAI BLVD
Practice Address - Street 2:
Practice Address - City:PAHOA
Practice Address - State:HI
Practice Address - Zip Code:96778-8909
Practice Address - Country:US
Practice Address - Phone:808-721-7613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-20-137982106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician