MEDICARE: JACQUELINE ATIENZA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist		HI

General Provider Information

NPI Number	:	1427509454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ATIENZA

Provider Business Mailing Address
First Line	:	91-614 POHAKUPUNA RD
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-2423
Country	:	US
Telephone Number	:	808-753-5990
Fax Number	:	808-784-0698

Provider Business Practice Location Address
First Line	:	91-614 POHAKUPUNA RD
Second Line	:
City	:	EWA BEACH
State	:	HI
Zip	:	96706-2423
Country	:	US
Telephone Number	:	808-753-5990
Fax Number	:	808-784-0698

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2016
Last Update Date	:	10/14/2016

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Directions to “ JACQUELINE ATIENZA ” Practice Location

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