Provider Demographics
NPI:1639701089
Name:MONTEBON, HAZEL LUAB
Entity type:Individual
Prefix:
First Name:HAZEL
Middle Name:LUAB
Last Name:MONTEBON
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:PO BOX 971305
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-8202
Mailing Address - Country:US
Mailing Address - Phone:808-748-1420
Mailing Address - Fax:
Practice Address - Street 1:94-312 HANAWAI CIR
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3003
Practice Address - Country:US
Practice Address - Phone:808-748-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIPUC532OtherPUC