Healthcare Provider Details

I. General information

NPI: 1912170473
Provider Name (Legal Business Name): PACIFIC IMAGING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-210 PUPUKAHI ST SUITE # 102
WAIPAHU HI
96797-2649
US

IV. Provider business mailing address

94-210 PUPUKAHI ST SUITE # 102
WAIPAHU HI
96797-2649
US

V. Phone/Fax

Practice location:
  • Phone: 808-330-3025
  • Fax: 808-838-7414
Mailing address:
  • Phone: 808-330-3025
  • Fax: 808-838-7414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number16759
License Number StateWA

VIII. Authorized Official

Name: OFELIA L LOO
Title or Position: TECHNICAL DIRECTOR
Credential:
Phone: 808-282-8603