Provider Demographics
NPI:1801450119
Name:PIMENTEL, MA NATALIE JOY
Entity type:Individual
Prefix:
First Name:MA NATALIE JOY
Middle Name:
Last Name:PIMENTEL
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 1:94-520 APII ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2867
Mailing Address - Country:US
Mailing Address - Phone:415-305-4057
Mailing Address - Fax:
Practice Address - Street 1:94-600 HONOWAI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1307
Practice Address - Country:US
Practice Address - Phone:808-307-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI92744163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIS00190080Medicaid