1336661727 NPI number — PAMELA CASTALDO WOOD BCBA 1-17-28098

Table of content: PAMELA CASTALDO WOOD BCBA 1-17-28098 (NPI 1336661727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336661727 NPI number — PAMELA CASTALDO WOOD BCBA 1-17-28098

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
PAMELA
Provider Middle Name:
CASTALDO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BCBA 1-17-28098
Provider Gender Code:
F

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:
1336661727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4510 SALT LAKE BLVD STE D8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96818-3172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-486-1804
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4510 SALT LAKE BLVD
Provider Second Line Business Practice Location Address:
D-8
Provider Business Practice Location Address City Name:
HONLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-486-1804
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1942689526 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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