Provider Demographics
NPI:1558070490
Name:AQUINO, JODY ANN KEHAULANI
Entity Type:Individual
Prefix:
First Name:JODY ANN
Middle Name:KEHAULANI
Last Name:AQUINO
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 1:45-514 OHA PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-5920
Mailing Address - Country:US
Mailing Address - Phone:808-224-5138
Mailing Address - Fax:
Practice Address - Street 1:98-027 HEKAHA ST STE 8
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4919
Practice Address - Country:US
Practice Address - Phone:808-224-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-16421225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist