Healthcare Provider Details

I. General information

NPI: 1265671820
Provider Name (Legal Business Name): PACIFIC AUTISM CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2009
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 AUAHI ST STE A6
HONOLULU HI
96813-5166
US

IV. Provider business mailing address

670 AUAHI ST STE A6
HONOLULU HI
96813-5166
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-8188
  • Fax: 808-523-1687
Mailing address:
  • Phone: 808-523-8188
  • Fax: 808-523-1687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY WARREN
Title or Position: PROGRAM SUPERVISOR
Credential: BCBA
Phone: 808-523-8188