1871269621 NPI number — AUTISM SPECIALISTS OF THE PACIFIC

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 1871269621 NPI number — AUTISM SPECIALISTS OF THE PACIFIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTISM SPECIALISTS OF THE PACIFIC
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:
1871269621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1043 MAKAWAO AVE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAKAWAO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96768-9468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-572-4500
Provider Business Mailing Address Fax Number:
808-442-1050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1043 MAKAWAO AVE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAKAWAO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96768-9468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-572-4500
Provider Business Practice Location Address Fax Number:
808-442-1050
Provider Enumeration Date:
08/20/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GALLER RIMM
Authorized Official First Name:
GABRIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-572-4500

Provider Taxonomy Codes

  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)