1427391994 NPI number — SURGERY CENTER OF THE PACIFIC, LLC

Table of content: CAMERON DEAN WAGENBRENNER MD (NPI 1063995561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427391994 NPI number — SURGERY CENTER OF THE PACIFIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGERY CENTER OF THE PACIFIC, 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:
1427391994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 S BERETANIA ST
Provider Second Line Business Mailing Address:
SUITE 420
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-1870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-947-2020
Provider Business Mailing Address Fax Number:
808-947-2088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 S BERETANIA ST
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96814-1870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-947-2020
Provider Business Practice Location Address Fax Number:
808-947-2088
Provider Enumeration Date:
04/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
HIGA
Authorized Official First Name:
HUGO
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
808-947-2020

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  W0601921701 , 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)





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