Healthcare Provider Details

I. General information

NPI: 1770412751
Provider Name (Legal Business Name): ANDREA LEANNE ARAULLO KONO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 KAYEN JOSE UNTALAN
DEDEDO GU
96929-2493
US

IV. Provider business mailing address

PO BOX 26875
BARRIGADA GU
96921-6875
US

V. Phone/Fax

Practice location:
  • Phone: 808-347-8539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: