Provider Demographics
NPI:1306483573
Name:DIGA, RANDY AGBAYANI
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:AGBAYANI
Last Name:DIGA
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 1:91-627 KILAHA ST APT 20
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2673
Mailing Address - Country:US
Mailing Address - Phone:206-816-9344
Mailing Address - Fax:
Practice Address - Street 1:91-627 KILAHA ST APT 20
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2673
Practice Address - Country:US
Practice Address - Phone:206-816-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI91799163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse