Provider Demographics
NPI:1396218582
Name:PINON, SAMANTHA SUZANNE (IDC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SUZANNE
Last Name:PINON
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MOFFET ST
Mailing Address - Street 2:
Mailing Address - City:JBPHH
Mailing Address - State:HI
Mailing Address - Zip Code:96853-5168
Mailing Address - Country:US
Mailing Address - Phone:808-448-4500
Mailing Address - Fax:
Practice Address - Street 1:1253 MAKALAPA ROAD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817
Practice Address - Country:US
Practice Address - Phone:808-472-0247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman