1982874491 NPI number — JINKY M NISPEROS PT

Table of content: JINKY M NISPEROS PT (NPI 1982874491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982874491 NPI number — JINKY M NISPEROS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NISPEROS
Provider First Name:
JINKY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOLINA
Provider Other First Name:
JINKY
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982874491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95-720 LANIKUHANA AVE
Provider Second Line Business Mailing Address:
140
Provider Business Mailing Address City Name:
MILILANI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96789-2985
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-623-6244
Provider Business Mailing Address Fax Number:
808-623-6414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95-720 LANIKUHANA AVE
Provider Second Line Business Practice Location Address:
140
Provider Business Practice Location Address City Name:
MILILANI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96789-2985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-623-6244
Provider Business Practice Location Address Fax Number:
808-623-6414
Provider Enumeration Date:
03/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 2857 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT 2857 . This is a "PT LICENSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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