Healthcare Provider Details

I. General information

NPI: 1568498699
Provider Name (Legal Business Name): ATTILIO AVINO JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-128 AIEA HEIGHTS DR SUITE 205
AIEA HI
96701-3932
US

IV. Provider business mailing address

99-128 AIEA HEIGHTS DR SUITE 205
AIEA HI
96701-3932
US

V. Phone/Fax

Practice location:
  • Phone: 808-487-6903
  • Fax: 808-487-6906
Mailing address:
  • Phone: 808-487-6903
  • Fax: 808-487-6906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO173
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: