Healthcare Provider Details

I. General information

NPI: 1033066964
Provider Name (Legal Business Name): HILORI WASTILA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 D AVE
CORONADO CA
92118-2113
US

IV. Provider business mailing address

611 CABRILLO AVE
CORONADO CA
92118-2027
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-8907
  • Fax: 619-437-0236
Mailing address:
  • Phone: 504-250-5316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number528156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: