Healthcare Provider Details

I. General information

NPI: 1225545056
Provider Name (Legal Business Name): CORINNA AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2018
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-955 KAMEHAMEHA HWY. #404
KANEOHE HI
96744
US

IV. Provider business mailing address

2355 MAKANANI DR
HONOLULU HI
96817-2040
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2973
  • Fax:
Mailing address:
  • Phone: 808-892-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number16-18109
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: