Healthcare Provider Details

I. General information

NPI: 1154888014
Provider Name (Legal Business Name): PACIFIC VASCULAR ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99-115 AIEA HEIGHTS DR STE 246
AIEA HI
96701-3914
US

IV. Provider business mailing address

98-1079 MOANALUA RD STE 620
AIEA HI
96701-4716
US

V. Phone/Fax

Practice location:
  • Phone: 314-973-9571
  • Fax: 808-486-5558
Mailing address:
  • Phone: 808-486-7775
  • Fax: 808-486-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. KAREN STRONG
Title or Position: DIRECTOR
Credential:
Phone: 314-973-9571