Healthcare Provider Details

I. General information

NPI: 1124585336
Provider Name (Legal Business Name): HEALTH FACILITY LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 PAOAKALANI AVE # 714
HONOLULU HI
96815-3764
US

IV. Provider business mailing address

229 PAOAKALANI AVE # 714
HONOLULU HI
96815-3764
US

V. Phone/Fax

Practice location:
  • Phone: 907-786-4401
  • Fax:
Mailing address:
  • Phone: 601-329-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JACOB CORNELIUS PARKER
Title or Position: SPECIALIST TECHNOLOGIST
Credential:
Phone: 601-329-1321