Provider Demographics
NPI:1346875788
Name:GENETIANO, FELIPA F
Entity Type:Individual
Prefix:
First Name:FELIPA
Middle Name:F
Last Name:GENETIANO
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 1:1305 NAKUINA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4143
Mailing Address - Country:US
Mailing Address - Phone:808-436-5460
Mailing Address - Fax:808-845-9018
Practice Address - Street 1:1305 NAKUINA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4143
Practice Address - Country:US
Practice Address - Phone:808-436-5460
Practice Address - Fax:808-845-9018
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI041006507376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIGE-022-934-4256-01Medicaid