Healthcare Provider Details

I. General information

NPI: 1306089404
Provider Name (Legal Business Name): JENNIE M. H. MONTIJO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIE MEI HERRINGTON DO

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-9056
  • Fax:
Mailing address:
  • Phone: 808-244-9056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP60192346
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDOS-1573
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: