Provider Demographics
NPI:1700523594
Name:CADIENTE, JANICE BALMORES
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:BALMORES
Last Name:CADIENTE
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 1:1031 GULICK AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4512
Mailing Address - Country:US
Mailing Address - Phone:808-724-3345
Mailing Address - Fax:
Practice Address - Street 1:1031 GULICK AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4512
Practice Address - Country:US
Practice Address - Phone:808-724-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-200062253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI000622Medicaid