Provider Demographics
NPI:1962731406
Name:BARAYUGA, FELY MALBOG (NURSE AID)
Entity type:Individual
Prefix:MRS
First Name:FELY
Middle Name:MALBOG
Last Name:BARAYUGA
Suffix:
Gender:F
Credentials:NURSE AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 BECKLEY ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3485
Mailing Address - Country:US
Mailing Address - Phone:808-277-8789
Mailing Address - Fax:808-845-5170
Practice Address - Street 1:1808 BECKLEY ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3485
Practice Address - Country:US
Practice Address - Phone:808-277-8789
Practice Address - Fax:808-845-5170
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW03705978-01172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker