Provider Demographics
NPI:1417059353
Name:CAFFIERO, TERESA L (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:CAFFIERO
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MAHALANI STREET
Mailing Address - Street 2:CARDIOVASCULAR SERVICES
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2526
Mailing Address - Country:US
Mailing Address - Phone:808-442-5504
Mailing Address - Fax:808-242-2535
Practice Address - Street 1:221 MAHALANI STREET
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2526
Practice Address - Country:US
Practice Address - Phone:808-244-9056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002229363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
206727Medicare ID - Type Unspecified
202172Medicare ID - Type Unspecified