Provider Demographics
NPI:1952666760
Name:ANDRES, GRACE CRISTOBAL
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:CRISTOBAL
Last Name:ANDRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1682 NOHOANA PL
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-5538
Mailing Address - Country:US
Mailing Address - Phone:808-959-4963
Mailing Address - Fax:
Practice Address - Street 1:1682 NOHOANA PL
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5538
Practice Address - Country:US
Practice Address - Phone:808-959-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI020400136376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide