Healthcare Provider Details

I. General information

NPI: 1831662808
Provider Name (Legal Business Name): PATRICK D BALBAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85-888 FARRINGTON HWY
WAIANAE HI
96792-2403
US

IV. Provider business mailing address

86-226 FARRINGTON HWY
WAIANAE HI
96792-3128
US

V. Phone/Fax

Practice location:
  • Phone: 808-696-9498
  • Fax: 808-696-9403
Mailing address:
  • Phone: 808-696-4211
  • Fax: 808-696-5516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XM0800X
TaxonomyMental Health Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: