Healthcare Provider Details

I. General information

NPI: 1801633763
Provider Name (Legal Business Name): CENTRAL HONOLULU THERAPY CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 LILIHA ST STE 1
HONOLULU HI
96817-3152
US

IV. Provider business mailing address

1619 LILIHA ST STE 1
HONOLULU HI
96817-3152
US

V. Phone/Fax

Practice location:
  • Phone: 808-528-1400
  • Fax: 808-531-5451
Mailing address:
  • Phone: 808-528-1400
  • Fax: 808-531-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LILIAN TACATA
Title or Position: OWNER
Credential:
Phone: 808-528-1400