Healthcare Provider Details

I. General information

NPI: 1902357072
Provider Name (Legal Business Name): TESSIE OBALDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TESSIE OBALDO PROVIDER

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-884 LUMIIKI ST.
WAIPAHU HI
96797
US

IV. Provider business mailing address

94-884 LUMIIKI ST.
WAIPAHU HI
96797
US

V. Phone/Fax

Practice location:
  • Phone: 808-729-3216
  • Fax: 808-200-5552
Mailing address:
  • Phone: 808-729-3216
  • Fax: 808-200-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: