Provider Demographics
NPI:1124869813
Name:AGUSTIN, MARINEL KATHRINA
Entity type:Individual
Prefix:
First Name:MARINEL KATHRINA
Middle Name:
Last Name:AGUSTIN
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 1:92-733 PAALA LOOP
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1628
Mailing Address - Country:US
Mailing Address - Phone:808-387-7832
Mailing Address - Fax:
Practice Address - Street 1:92-733 PAALA LOOP
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-1628
Practice Address - Country:US
Practice Address - Phone:808-387-7832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies