Healthcare Provider Details

I. General information

NPI: 1639515679
Provider Name (Legal Business Name): DEPT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

IV. Provider business mailing address

459 PATTERSON RD
HONOLULU HI
96819-1522
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-7853
  • Fax:
Mailing address:
  • Phone: 808-433-7853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number619
License Number StateHI

VIII. Authorized Official

Name: MRS. LINDA NIINO
Title or Position: SOCIAL WORKER
Credential: MSW
Phone: 808-433-7853