Provider Demographics
NPI:1598215048
Name:PINO, MIKALA G (PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:MIKALA
Middle Name:G
Last Name:PINO
Suffix:
Gender:F
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:MIKALA
Other - Middle Name:GUADALUPE
Other - Last Name:MEJIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 KAMOKILA BLVD
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-432-3600
Mailing Address - Fax:
Practice Address - Street 1:401 KAMOKILA BLVD
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-432-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-08
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
HIAT-1122255A2300X
HIAMD-722363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer