Healthcare Provider Details

I. General information

NPI: 1417059353
Provider Name (Legal Business Name): TERESA L CAFFIERO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 MAUI LANI PKWY
WAILUKU HI
96793-2416
US

IV. Provider business mailing address

85 MAUI LANI PKWY
WAILUKU HI
96793-2416
US

V. Phone/Fax

Practice location:
  • Phone: 808-442-5700
  • Fax: 855-827-2321
Mailing address:
  • Phone: 808-442-5700
  • Fax: 855-827-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085002229
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: