Provider Demographics
NPI:1891394367
Name:TUMBAGA, TRINIDAD NACAPUY
Entity type:Individual
Prefix:
First Name:TRINIDAD
Middle Name:NACAPUY
Last Name:TUMBAGA
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 1:91-993 KEONEAE PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4720
Mailing Address - Country:US
Mailing Address - Phone:808-397-9070
Mailing Address - Fax:
Practice Address - Street 1:91-993 KEONEAE PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-4720
Practice Address - Country:US
Practice Address - Phone:808-397-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI512261Medicaid