Active NPI
Darylle Dave Rebano Agustin
- Nurse's Aide
- Pearl City, HI
National Provider Identifier
1982123956
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- 1170030
- Practice address
- 1108 Noelani St
Pearl City, HI 96782-2932 - Phone
- (808) 724-1338
- Fax
- (808) 200-5211
- NPI assigned
- Sep 11, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | 1170030 | HI | Primary |
Addresses
Primary practice location
1108 Noelani St
Pearl City, HI 96782-2932
Mailing address
1108 Noelani St
Pearl City, HI 96782-2932
Phone (808) 724-1338
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1170030 | Medicaid | HI |
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 |
|---|---|---|---|
| 1170030 | HI | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1505088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1982123956",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1108 NOELANI ST",
"city": "PEARL CITY",
"state": "HI",
"postal_code": "967822932",
"telephone_number": "808-724-1338",
"fax_number": "808-200-5211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1108 NOELANI ST",
"city": "PEARL CITY",
"state": "HI",
"postal_code": "967822932",
"telephone_number": "808-724-1338",
"fax_number": "808-200-5211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGUSTIN",
"first_name": "DARYLLE DAVE",
"middle_name": "REBANO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-09-11",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "HI",
"license": "1170030",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1170030",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pearl City, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.