Active NPI
Gwendolyn Buenavista Coloma Cabaccang
- Driver
- Aiea, HI
National Provider Identifier
1821723248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- 1606814678
- Practice address
- 98-820 Moanalua Rd SPC 5-726
Aiea, HI 96701-5200 - Phone
- (808) 342-1611
- Fax
- (808) 443-0943
- NPI assigned
- Jul 20, 2022
- Last updated
- Jul 20, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 1606814678 | NV | Primary |
Addresses
Primary practice location
98-820 Moanalua Rd SPC 5-726
Aiea, HI 96701-5200
Mailing address
98-820 Moanalua Rd SPC 5-726
Aiea, HI 96701-5200
Phone (808) 342-1611
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1606814678 | NV | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1658275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658275200000",
"number": "1821723248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "98-820 MOANALUA RD SPC 5-726",
"city": "AIEA",
"state": "HI",
"postal_code": "967015200",
"telephone_number": "808-342-1611",
"fax_number": "808-443-0943"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "98-820 MOANALUA RD SPC 5-726",
"city": "AIEA",
"state": "HI",
"postal_code": "967015200",
"telephone_number": "808-342-1611",
"fax_number": "808-443-0943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLOMA CABACCANG",
"first_name": "GWENDOLYN",
"middle_name": "BUENAVISTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-07-20",
"last_updated": "2022-07-20",
"certification_date": "2022-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "NV",
"license": "1606814678",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aiea, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.