Basic Information
Provider Information | |||||||||
NPI: | 1477781227 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PINEDA | ||||||||
FirstName: | MARIA | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MSN-APN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | FAJARDO | ||||||||
OtherFirstName: | MARIA | ||||||||
OtherMiddleName: | J | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | NP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 677 ALA MOANA BLVD STE 1001 | ||||||||
Address2: |   | ||||||||
City: | HONOLULU | ||||||||
State: | HI | ||||||||
PostalCode: | 968135408 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8084694900 | ||||||||
FaxNumber: | 8085367315 | ||||||||
Practice Location | |||||||||
Address1: | 3001 BOXER RD | ||||||||
Address2: |   | ||||||||
City: | KAPOLEI | ||||||||
State: | HI | ||||||||
PostalCode: | 967072103 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8088616834 | ||||||||
FaxNumber: | 8085367315 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/30/2009 | ||||||||
LastUpdateDate: | 10/18/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN1627 | HI | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 001110 | NV | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.