Provider Demographics
NPI:1568498699
Name:AVINO, ATTILIO JR (DPM)
Entity Type:Individual
Prefix:
First Name:ATTILIO
Middle Name:
Last Name:AVINO
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-128 AIEA HEIGHTS DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3932
Mailing Address - Country:US
Mailing Address - Phone:808-487-6903
Mailing Address - Fax:808-487-6906
Practice Address - Street 1:99-128 AIEA HEIGHTS DR
Practice Address - Street 2:SUITE 205
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3932
Practice Address - Country:US
Practice Address - Phone:808-487-6903
Practice Address - Fax:808-487-6906
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO173213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000251553OtherHMSA
HI4181619OtherUHA
HI521648OtherHMN
HI565921Medicaid
HI565921Medicaid
HIH100284Medicare PIN