Provider Demographics
NPI:1174392617
Name:BUMANGLAG, CONSTANCIO G JR (PBT, ASCP)
Entity type:Individual
Prefix:MR
First Name:CONSTANCIO
Middle Name:G
Last Name:BUMANGLAG
Suffix:JR
Gender:M
Credentials:PBT, ASCP
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Mailing Address - Street 1:91 1001 KEAUNUI DRIVE
Mailing Address - Street 2:215
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706
Mailing Address - Country:US
Mailing Address - Phone:808-393-8073
Mailing Address - Fax:808-517-5173
Practice Address - Street 1:91 1001 KEAUNUI DRIVE
Practice Address - Street 2:215
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-393-8073
Practice Address - Fax:808-517-5173
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
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Provider Licenses
StateLicense IDTaxonomies
HI68986246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy