Basic Information
| Provider Information | |||||||||
| NPI: | 1063402469 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JANCATERINO | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 OLOHANA ST | ||||||||
| Address2: | #2903 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5087417626 | ||||||||
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| Practice Location | |||||||||
| Address1: | MAUI MEMORIAL MEDICAL CENTER | ||||||||
| Address2: | 221 MAHALANI ST | ||||||||
| City: | WAILUKU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082422290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 7648 | HI | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3086674 | 05 | MA | MEDICAID |