Healthcare Provider Details

I. General information

NPI: 1669911640
Provider Name (Legal Business Name): ARIEL M BERRIOS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

385 HUKILIKE ST SUITE 210
KAHULUI HI
96732-3522
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-9056
  • Fax:
Mailing address:
  • Phone: 808-871-8346
  • Fax: 808-871-8344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberAMD-736
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: