Provider Demographics
NPI:1497242325
Name:MATUTINO, SHARON VISITACION
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:VISITACION
Last Name:MATUTINO
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 1:4821 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-4025
Mailing Address - Country:US
Mailing Address - Phone:808-741-0464
Mailing Address - Fax:
Practice Address - Street 1:4821 SIERRA DR
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-4025
Practice Address - Country:US
Practice Address - Phone:808-741-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator