Provider Demographics
NPI:1558998872
Name:ORTAL, ERLINDA D (CCFFH OPERATOR)
Entity Type:Individual
Prefix:
First Name:ERLINDA
Middle Name:D
Last Name:ORTAL
Suffix:
Gender:F
Credentials:CCFFH OPERATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1060 HAMANA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3938
Mailing Address - Country:US
Mailing Address - Phone:808-421-8080
Mailing Address - Fax:
Practice Address - Street 1:91-1060 HAMANA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3938
Practice Address - Country:US
Practice Address - Phone:808-421-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI511289174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist