Provider Demographics
NPI:1366586034
Name:RICALDE-SARONITMAN, LEILANI ATIENZA (APRN-RX, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:LEILANI
Middle Name:ATIENZA
Last Name:RICALDE-SARONITMAN
Suffix:
Gender:F
Credentials:APRN-RX, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-2141 FORT WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1993
Mailing Address - Country:US
Mailing Address - Phone:808-691-3050
Mailing Address - Fax:808-691-3827
Practice Address - Street 1:91-2141 FORT WEAVER RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1993
Practice Address - Country:US
Practice Address - Phone:808-691-3050
Practice Address - Fax:808-691-3827
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI25594OtherHMSA
HI990073526OtherHMAA
HI574253Medicaid
HIQ52910Medicare UPIN