Healthcare Provider Details

I. General information

NPI: 1104379536
Provider Name (Legal Business Name): CPC HAWAII LIFE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ALA MOANA BLVD UNIT 9
HONOLULU HI
96814-4200
US

IV. Provider business mailing address

1330 ALA MOANA BLVD UNIT 9
HONOLULU HI
96814-4200
US

V. Phone/Fax

Practice location:
  • Phone: 808-945-5433
  • Fax: 808-380-1465
Mailing address:
  • Phone: 808-945-5433
  • Fax: 808-380-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberDOS696
License Number StateHI

VIII. Authorized Official

Name: DR. MICHAEL ANTHONY PASQUALE
Title or Position: CEO
Credential: D.O.
Phone: 808-945-5433