1376959650 NPI number — PHYSICAL & INDUSTRIAL REHABILITATION CLINIC OF OAHU LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376959650 NPI number — PHYSICAL & INDUSTRIAL REHABILITATION CLINIC OF OAHU LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICAL & INDUSTRIAL REHABILITATION CLINIC OF OAHU 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:
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:
1376959650
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 KAPIOLANI BLVD
Provider Second Line Business Mailing Address:
STE 820
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-3503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-524-5247
Provider Business Mailing Address Fax Number:
808-440-5251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2810 PAA ST
Provider Second Line Business Practice Location Address:
BUILDING A
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96819-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-524-5247
Provider Business Practice Location Address Fax Number:
808-440-5251
Provider Enumeration Date:
07/07/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MIZOGUCHI
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-524-5247

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: OT151 , 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 © 2007-2026 www.npivalidator.com