1417689043 NPI number — JESSICA NALANI JICHA LARIEGO RN

Table of content: JESSICA NALANI JICHA LARIEGO RN (NPI 1417689043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417689043 NPI number — JESSICA NALANI JICHA LARIEGO RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARIEGO
Provider First Name:
JESSICA
Provider Middle Name:
NALANI JICHA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JICHA
Provider Other First Name:
JESSICA
Provider Other Middle Name:
NALANI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417689043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
94-970 LUMIAUAU ST APT F103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAIPAHU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96797-4828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-216-2591
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 BISHOP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813-4124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-356-4357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2022

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: 163WP0200X , with the licence number:  RN-91272 , 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)