Provider Demographics
NPI:1427804665
Name:PETRILL-ABROJINA, KAUANOE SHANTEL
Entity type:Individual
Prefix:
First Name:KAUANOE
Middle Name:SHANTEL
Last Name:PETRILL-ABROJINA
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 1:8615 FLETCHER PKWY UNIT 318
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5204
Mailing Address - Country:US
Mailing Address - Phone:619-539-3459
Mailing Address - Fax:
Practice Address - Street 1:1031 25TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-2194
Practice Address - Country:US
Practice Address - Phone:619-539-3459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program