Healthcare Provider Details

I. General information

NPI: 1780279323
Provider Name (Legal Business Name): REY YENKO ORTIZ CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 S KING ST
HONOLULU HI
96813-3009
US

IV. Provider business mailing address

888 S KING ST
HONOLULU HI
96813-3009
US

V. Phone/Fax

Practice location:
  • Phone: 808-522-4622
  • Fax:
Mailing address:
  • Phone: 808-522-4622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN-5299
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: