Alyssandra Nazareno Baniqued, MD

Individual provider Active NPI Family Medicine Physician · Aiea, HI

NPI 1508553009 · NPPES record last updated Apr 24, 2023

Key facts

NPI
1508553009
Entity type
Individual (NPI type 1)
Primary specialty
Family Medicine Physician 207Q00000X
License
MDR-8492-0 (HI)
Practice address
98-1005 Moanalua Rd SPC 3030
Aiea, HI 96701-4735
Phone
(808) 284-9797
NPI assigned
Apr 24, 2023
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MDR-8492-0HIMDFamily Medicine Physician

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MDR-8492-0 HI Yes

Addresses

Primary practice location

98-1005 Moanalua Rd SPC 3030
Aiea, HI 96701-4735

Mailing address

98-1005 Moanalua Rd SPC 3030
Aiea, HI 96701-4735

Other providers in Aiea, HI

All providers in Aiea, HI · Family Medicine Physician in Hawaii

Sources for this page

Verify at the official NPI Registry.