Provider Demographics
NPI:1942552591
Name:MARTINO, ENRIQUE
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:MARTINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-5049
Mailing Address - Country:US
Mailing Address - Phone:808-664-3941
Mailing Address - Fax:
Practice Address - Street 1:2001 VICTOR WHARF ACCESS RD
Practice Address - Street 2:BUILDING 987
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3400
Practice Address - Country:US
Practice Address - Phone:808-474-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman