Provider Demographics
NPI:1669100590
Name:CARREIRO, KAIULANI ROSEMARY JANE (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:KAIULANI
Middle Name:ROSEMARY JANE
Last Name:CARREIRO
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 ALCATRAZ AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2653
Mailing Address - Country:US
Mailing Address - Phone:510-875-3015
Mailing Address - Fax:
Practice Address - Street 1:1631 ALCATRAZ AVE APT A
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2653
Practice Address - Country:US
Practice Address - Phone:510-875-3015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor