1619013497 NPI number — MR. WALTER FREDERICK REED MFT, CSAC

Table of content: MR. WALTER FREDERICK REED MFT, CSAC (NPI 1619013497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619013497 NPI number — MR. WALTER FREDERICK REED MFT, CSAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED
Provider First Name:
WALTER
Provider Middle Name:
FREDERICK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MFT, CSAC
Provider Gender Code:
M

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:
1619013497
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 WAI NANI WAY
Provider Second Line Business Mailing Address:
#815
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-852-9646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99-128 AIEA HEIGHTS DRIVE
Provider Second Line Business Practice Location Address:
#704
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-852-9646
Provider Business Practice Location Address Fax Number:
808-484-9400
Provider Enumeration Date:
01/29/2007

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 176 , 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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