Provider Demographics
NPI:1902357072
Name:OBALDO, TESSIE
Entity Type:Individual
Prefix:
First Name:TESSIE
Middle Name:
Last Name:OBALDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TESSIE
Other - Middle Name:
Other - Last Name:OBALDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PROVIDER
Mailing Address - Street 1:94-884 LUMIIKI ST.
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797
Mailing Address - Country:US
Mailing Address - Phone:808-729-3216
Mailing Address - Fax:808-200-5552
Practice Address - Street 1:94-884 LUMIIKI ST.
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797
Practice Address - Country:US
Practice Address - Phone:808-729-3216
Practice Address - Fax:808-200-5552
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI$$$$$$$$$OtherPROVIDER