Healthcare Provider Details

I. General information

NPI: 1700847274
Provider Name (Legal Business Name): THE PACIFIC INSTITUTE OF HUMAN RESTORATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST STE 709
HONOLULU HI
96813
US

IV. Provider business mailing address

820 MILILANI ST STE 702A
HONOLULU HI
96813
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-5033
  • Fax: 808-528-4713
Mailing address:
  • Phone: 808-523-9363
  • Fax: 808-523-9418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD11371
License Number StateHI

VIII. Authorized Official

Name: MARIA B HONNEBIER
Title or Position: OWNER
Credential: MD
Phone: 808-523-9363