Provider Demographics
NPI:1881310340
Name:FUNTANILLA, STEPHANIE (BA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:FUNTANILLA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 KELE ST STE 203
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1803
Mailing Address - Country:US
Mailing Address - Phone:808-338-0252
Mailing Address - Fax:
Practice Address - Street 1:9875 WAIMEA ROAD
Practice Address - Street 2:
Practice Address - City:WAIMEA
Practice Address - State:HI
Practice Address - Zip Code:96796
Practice Address - Country:US
Practice Address - Phone:808-338-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator