Healthcare Provider Details

I. General information

NPI: 1801231121
Provider Name (Legal Business Name): SYLVIA AN ROSS PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-6224 MAMALAHOA HWY B3
CAPTAIN COOK HI
96704-8111
US

IV. Provider business mailing address

PO BOX 736
CAPTAIN COOK HI
96704-0736
US

V. Phone/Fax

Practice location:
  • Phone: 808-938-2260
  • Fax: 888-805-1547
Mailing address:
  • Phone: 808-938-2260
  • Fax: 888-805-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1203
License Number StateHI

VIII. Authorized Official

Name: DR. SYLVIA AN ROSS
Title or Position: PSYCHOLOGIST
Credential: PH.D.
Phone: 808-938-2260