Healthcare Provider Details

I. General information

NPI: 1225318454
Provider Name (Legal Business Name): PACIFIC NEUROPSYCHOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 04/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 HOBRON LN STE 409
HONOLULU HI
96815-1229
US

IV. Provider business mailing address

PO BOX 3805
HONOLULU HI
96812-3805
US

V. Phone/Fax

Practice location:
  • Phone: 808-599-7676
  • Fax: 808-599-7900
Mailing address:
  • Phone: 808-599-7676
  • Fax: 808-599-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1157
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1157
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number1157
License Number StateHI
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1157
License Number StateHI

VIII. Authorized Official

Name: DR. LAILA SPINA
Title or Position: NEUROPSYCHOLOGIST
Credential:
Phone: 808-599-7676