Healthcare Provider Details

I. General information

NPI: 1013686716
Provider Name (Legal Business Name): ANGELA OLORTEGUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1193 MOKAPU RD
KAILUA HI
96734-5010
US

IV. Provider business mailing address

5004 SAN ANTONIO CIR
KAILUA HI
96734-4775
US

V. Phone/Fax

Practice location:
  • Phone: 808-254-7944
  • Fax:
Mailing address:
  • Phone: 917-428-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9451871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: