1700847274 NPI number — THE PACIFIC INSTITUTE OF HUMAN RESTORATION LLC

Table of content: (NPI 1700847274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700847274 NPI number — THE PACIFIC INSTITUTE OF HUMAN RESTORATION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PACIFIC INSTITUTE OF HUMAN RESTORATION LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HONNEBIER MARIA B
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700847274
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 MILILANI ST
Provider Second Line Business Mailing Address:
STE 702A
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-523-9363
Provider Business Mailing Address Fax Number:
808-523-9418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1329 LUSITANA ST
Provider Second Line Business Practice Location Address:
STE 709
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-523-5033
Provider Business Practice Location Address Fax Number:
808-528-4713
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HONNEBIER
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-523-9363

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD11371 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000254102 . This is a "HMSA" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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