1346447976 NPI number — CENTER FOR INTEGRATIVE THERAPY

Table of content: (NPI 1346447976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346447976 NPI number — CENTER FOR INTEGRATIVE THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR INTEGRATIVE THERAPY
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:
1346447976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4938
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96745-4938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-329-7176
Provider Business Mailing Address Fax Number:
808-326-1279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77-6425 KUAKINI HWY
Provider Second Line Business Practice Location Address:
SUITE D-102
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-3213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-329-7176
Provider Business Practice Location Address Fax Number:
808-326-1279
Provider Enumeration Date:
06/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WANG
Authorized Official First Name:
SOPHIA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
EXECUTIVE OFFICER
Authorized Official Telephone Number:
808-329-7176

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY1104 , 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)





Copyright © 2007-2025 www.npivalidator.com