Healthcare Provider Details

I. General information

NPI: 1902980378
Provider Name (Legal Business Name): PEDIATRIC CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 NORTH KALAHEO AVE C103
KAILUA HI
96734
US

IV. Provider business mailing address

970 NORTH KALAHEO AVE C103
KAILUA HI
96734
US

V. Phone/Fax

Practice location:
  • Phone: 808-254-6474
  • Fax: 808-254-6400
Mailing address:
  • Phone: 808-254-6474
  • Fax: 808-254-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT E ANDERSON
Title or Position: PRESIDENT
Credential: MD
Phone: 808-254-6474