Provider Demographics
NPI:1679921167
Name:SAGUCIO, MA CORAZON (PT, DPT)
Entity type:Individual
Prefix:
First Name:MA CORAZON
Middle Name:
Last Name:SAGUCIO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MA CORAZON
Other - Middle Name:ALTONAGA
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1146 HALA DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2125
Mailing Address - Country:US
Mailing Address - Phone:808-634-4004
Mailing Address - Fax:
Practice Address - Street 1:2230 LILIHA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-1646
Practice Address - Country:US
Practice Address - Phone:808-547-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-2986225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist