=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700591948
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNA-LIA G QUINIO MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2023
-----------------------------------------------------
Last Update Date | 03/18/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45-955 KAMEHAMEHA HWY STE 300
-----------------------------------------------------
City | KANEOHE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96744-3292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-745-0789
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 45-955 KAMEHAMEHA HWY STE 300
-----------------------------------------------------
City | KANEOHE
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96744-3292
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-234-6383
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING SPECIALIST
-----------------------------------------------------
Name | JESSICA FIESTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 808-222-7794
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------