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General NPI Number Information
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NPI Number | 1467040568
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Entity Type | Individual
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Provider Name | JENNY DOMINGO PONCIANO RN
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Gender | Female
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Dates
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Enumeration Date | 01/05/2021
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 94-1132 LUMIAUAU ST
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City | WAIPAHU
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State | HI
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Zip | 96797-3922
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Country | US
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Telephone | 808-636-1274
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Fax | 808-082-6041
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Provider Business Mailing Address
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Address Line | 94-1132 LUMIAUAU ST
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City | WAIPAHU
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State | HI
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Zip | 96797-3922
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Country | US
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Telephone | 808-636-1274
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Fax | 808-082-6041
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 1-200047
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License Number State | HI
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