Provider Demographics
NPI:1144659608
Name:GALUSHA-SAGOCIO, ALYSSA M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:M
Last Name:GALUSHA-SAGOCIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:M
Other - Last Name:GALUSHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:92-1239 HOOKEHA ST
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-1533
Mailing Address - Country:US
Mailing Address - Phone:808-799-8554
Mailing Address - Fax:
Practice Address - Street 1:770 KAPIOLANI BLVD
Practice Address - Street 2:#705
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-597-8791
Practice Address - Fax:808-597-8781
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant