1043926231 NPI number — DR. HORINOUCHI WELLNESS CLINIC

Table of content: LAWRENCE JOSEPH BEAN III (NPI 1265105084)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043926231 NPI number — DR. HORINOUCHI WELLNESS CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. HORINOUCHI WELLNESS CLINIC
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:
Provider Other Organization Name Type Code:
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:
1043926231
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 CHALAN SAN ANTONIO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96913-3525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-646-9333
Provider Business Mailing Address Fax Number:
671-646-9334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 CHALAN SAN ANTONIO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96913-3525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-646-9333
Provider Business Practice Location Address Fax Number:
671-646-9334
Provider Enumeration Date:
01/30/2023

Additional Information

Authorized Official

Authorized Official Last Name:
HORINOUCHI
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
Authorized Official Title or Position:
NUTRITION SPECIALIST
Authorized Official Telephone Number:
671-646-9333

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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