Healthcare Provider Details

I. General information

NPI: 1942638689
Provider Name (Legal Business Name): HONOLULU PSYCHIATRIC SERCIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1188 BISHOP ST STE 1102
HONOLULU HI
96813-3304
US

IV. Provider business mailing address

1188 BISHOP ST STE 1102
HONOLULU HI
96813-3304
US

V. Phone/Fax

Practice location:
  • Phone: 808-388-4969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15998
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number15998
License Number StateHI

VIII. Authorized Official

Name: DR. RAYMOND DAVIDSON
Title or Position: OWNER
Credential: MD
Phone: 808-388-4969