Provider Demographics
NPI:1811034994
Name:CASINO, MARIVYN AURELIO (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MARIVYN
Middle Name:AURELIO
Last Name:CASINO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1035 OPAEHUNA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3566
Mailing Address - Country:US
Mailing Address - Phone:808-677-5805
Mailing Address - Fax:808-671-5591
Practice Address - Street 1:91-1035 OPAEHUNA ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3566
Practice Address - Country:US
Practice Address - Phone:808-677-5805
Practice Address - Fax:808-671-5591
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI121917970690F376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI512378Medicaid