Provider Demographics
NPI:1225458615
Name:PRIETO, JEAN
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:PRIETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-102 AKEKEE PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3920
Mailing Address - Country:US
Mailing Address - Phone:808-681-6358
Mailing Address - Fax:808-681-6819
Practice Address - Street 1:91-102 AKEKEE PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3920
Practice Address - Country:US
Practice Address - Phone:808-681-6358
Practice Address - Fax:808-681-6819
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3112ZA0620X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker