Provider Demographics
NPI:1982011581
Name:ASENTISTA, NATTI (NA)
Entity Type:Individual
Prefix:MRS
First Name:NATTI
Middle Name:
Last Name:ASENTISTA
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-515 KAHUANANI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3515
Mailing Address - Country:US
Mailing Address - Phone:808-888-7070
Mailing Address - Fax:808-888-7070
Practice Address - Street 1:94-515 KAHUANANI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3515
Practice Address - Country:US
Practice Address - Phone:808-888-7070
Practice Address - Fax:808-888-7070
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI918920OtherOHANA HEALTH PLAN