Provider Demographics
NPI:1598708125
Name:ADLAWAN, JACQUELINE FERNANDEZ
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:FERNANDEZ
Last Name:ADLAWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:PULANCO
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:95-390 KUAHELANI AVE
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1192
Mailing Address - Country:US
Mailing Address - Phone:808-627-3255
Mailing Address - Fax:808-627-3265
Practice Address - Street 1:98-1005 MOANALUA ROAD
Practice Address - Street 2:SUITE 3030
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4735
Practice Address - Country:US
Practice Address - Phone:808-627-3255
Practice Address - Fax:808-627-3265
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450060NP363LF0000X
HIMDR-7684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9646761Medicaid