Healthcare Provider Details

I. General information

NPI: 1609280544
Provider Name (Legal Business Name): JESUS EDINSON PINO MORENO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S BERETANIA ST STE 610
HONOLULU HI
96813-2496
US

IV. Provider business mailing address

550 S BERETANIA ST STE 610
HONOLULU HI
96813-2496
US

V. Phone/Fax

Practice location:
  • Phone: 808-691-8512
  • Fax: 808-691-8513
Mailing address:
  • Phone: 808-691-8512
  • Fax: 808-691-8513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD-21828
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: