Provider Demographics
NPI:1093322208
Name:ISIDRO, JELSA MARTICIO (TRANSPORTATION)
Entity Type:Individual
Prefix:
First Name:JELSA
Middle Name:MARTICIO
Last Name:ISIDRO
Suffix:
Gender:F
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-0207
Mailing Address - Country:US
Mailing Address - Phone:808-936-6547
Mailing Address - Fax:808-327-9462
Practice Address - Street 1:75-5915 WALUA RD
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1375
Practice Address - Country:US
Practice Address - Phone:808-936-6547
Practice Address - Fax:808-327-9462
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)