Provider Demographics
NPI:1104996701
Name:MACARAIG, WALTER FERMIN
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:FERMIN
Last Name:MACARAIG
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 1:94-1063 HAALAU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4540
Mailing Address - Country:US
Mailing Address - Phone:808-677-8875
Mailing Address - Fax:808-677-8875
Practice Address - Street 1:94-1063 HAALAU ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4540
Practice Address - Country:US
Practice Address - Phone:808-677-8875
Practice Address - Fax:808-677-8875
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies