Provider Demographics
NPI:1285314161
Name:BARAYUGA, EXCEL
Entity type:Individual
Prefix:
First Name:EXCEL
Middle Name:
Last Name:BARAYUGA
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 1:73-1320 ONAONA DR UNIT 16A
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-9688
Mailing Address - Country:US
Mailing Address - Phone:808-384-3321
Mailing Address - Fax:
Practice Address - Street 1:75-5870 WALUA RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1392
Practice Address - Country:US
Practice Address - Phone:808-323-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant