Provider Demographics
NPI:1275596637
Name:DITTO, JANET (PA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:DITTO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 5851 KUAKINI HWY
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:808-854-3566
Mailing Address - Fax:808-326-4450
Practice Address - Street 1:75-5851 KUAKINI HWY
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2199
Practice Address - Country:US
Practice Address - Phone:808-854-3566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD-790363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2750394CMedicare ID - Type Unspecified
NCS77829Medicare UPIN
NC2750394DMedicare ID - Type Unspecified