Healthcare Provider Details

I. General information

NPI: 1265462220
Provider Name (Legal Business Name): JASON C GLIPA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 KAPIOLANI BLVD SUITE 620
HONOLULU HI
96814-3807
US

IV. Provider business mailing address

1188 BISHOP ST SUITE 3007
HONOLULU HI
96813-3312
US

V. Phone/Fax

Practice location:
  • Phone: 808-779-1799
  • Fax:
Mailing address:
  • Phone: 808-599-1636
  • Fax: 808-599-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD8662
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: