Provider Demographics
NPI:1356412944
Name:DINIEGA, LETICIA GARCIA (MD)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:GARCIA
Last Name:DINIEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2139 FORT WEAVER RD
Mailing Address - Street 2:STE 201
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3608
Mailing Address - Country:US
Mailing Address - Phone:808-678-0878
Mailing Address - Fax:808-678-0818
Practice Address - Street 1:91-2139 FORT WEAVER RD
Practice Address - Street 2:STE 201
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3608
Practice Address - Country:US
Practice Address - Phone:808-678-0878
Practice Address - Fax:808-678-0818
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD9169207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00217506Medicaid
G49230Medicare UPIN
HI00217506Medicaid