Provider Demographics
NPI:1861265175
Name:DAPON, JACKIEFLOR B
Entity type:Individual
Prefix:
First Name:JACKIEFLOR
Middle Name:B
Last Name:DAPON
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 1:91-1537 MILIMILI ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5674
Mailing Address - Country:US
Mailing Address - Phone:808-807-3412
Mailing Address - Fax:808-460-4008
Practice Address - Street 1:91-1537 MILIMILI ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5674
Practice Address - Country:US
Practice Address - Phone:808-807-3412
Practice Address - Fax:808-460-4008
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI67251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management