Provider Demographics
NPI:1538523212
Name:MONTIJO, NOREEN
Entity type:Individual
Prefix:
First Name:NOREEN
Middle Name:
Last Name:MONTIJO
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 1:94-833 KALAIAHA PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4527
Mailing Address - Country:US
Mailing Address - Phone:808-829-5181
Mailing Address - Fax:808-600-5204
Practice Address - Street 1:94-833 KALAIAHA PL
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4527
Practice Address - Country:US
Practice Address - Phone:808-829-5181
Practice Address - Fax:808-600-5204
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIW74393950-01311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home