Healthcare Provider Details

I. General information

NPI: 1992915086
Provider Name (Legal Business Name): PLASTIC SURGERY CTR OF THE PAC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 ALA MOANA BLVD STE 1011
HONOLULU HI
96813-5471
US

IV. Provider business mailing address

677 ALA MOANA BLVD STE 1011
HONOLULU HI
96813-5471
US

V. Phone/Fax

Practice location:
  • Phone: 808-521-1999
  • Fax:
Mailing address:
  • Phone: 808-521-1999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1709
License Number StateHI

VIII. Authorized Official

Name: DR. ROBERT FLOWERS
Title or Position: CEO
Credential:
Phone: 808-521-1999