Healthcare Provider Details

I. General information

NPI: 1265609283
Provider Name (Legal Business Name): NCL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85-175 FARRINGTON HWY B-301
WAIANAE HI
96792
US

IV. Provider business mailing address

85-175 FARRINGTON HWY B-301
WAIANAE HI
96792-2154
US

V. Phone/Fax

Practice location:
  • Phone: 808-989-0865
  • Fax:
Mailing address:
  • Phone: 808-989-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberDOS-787
License Number StateHI

VIII. Authorized Official

Name: DR. PAUL THOMAS OCONNOR
Title or Position: MEDICAL DOCTOR
Credential: D.O.
Phone: 808-989-0865