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

Table of content: (NPI 1376959650)

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 © 2007-2025 www.npivalidator.com