Healthcare Provider Details

I. General information

NPI: 1629711841
Provider Name (Legal Business Name): VANESSA K ANTONIO-IGNACIO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA K IGNACIO

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PENSACOLA ST
HONOLULU HI
96814-2118
US

IV. Provider business mailing address

254 ANELA ST
HILO HI
96720-5410
US

V. Phone/Fax

Practice location:
  • Phone: 808-932-3730
  • Fax:
Mailing address:
  • Phone: 808-430-8826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDOS-2648
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: