Basic Information
| Provider Information | |||||||||
| NPI: | 1346789112 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEL RIO | ||||||||
| FirstName: | KATIE | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4125 KAHAKAHA LN | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967346840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8083754925 | ||||||||
| FaxNumber: | 9492534627 | ||||||||
| Practice Location | |||||||||
| Address1: | 11037 WARNER AVE # 339 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927084007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002734292 | ||||||||
| FaxNumber: | 9492534627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2017 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | HI | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.