Basic Information
| Provider Information | |||||||||
| NPI: | 1144659608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALUSHA-SAGOCIO | ||||||||
| FirstName: | ALYSSA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GALUSHA | ||||||||
| OtherFirstName: | ALYSSA | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 92-1239 HOOKEHA ST | ||||||||
| Address2: | |||||||||
| City: | KAPOLEI | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967071533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087998554 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 770 KAPIOLANI BLVD | ||||||||
| Address2: | #705 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085978791 | ||||||||
| FaxNumber: | 8085978781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2013 | ||||||||
| LastUpdateDate: | 07/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | AMD-547 | HI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.