Healthcare Provider Details

I. General information

NPI: 1265413066
Provider Name (Legal Business Name): ARLEEN RONQUILLO M.S., PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 888-683-2778
  • Fax:
Mailing address:
  • Phone: 808-433-6661
  • Fax: 808-433-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD236
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: