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General NPI Number Information
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NPI Number | 1194842674
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Entity Type | Organization
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Legal Business Name | PEDIATRIC PROFESSIONALS, INC.
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1350 S KING ST STE 300
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City | HONOLULU
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State | HI
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Zip | 96814-2066
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Country | US
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Telephone | 808-593-9944
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Fax | 808-593-0565
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Provider Business Mailing Address
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Address Line | 1350 S KING ST STE 300
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City | HONOLULU
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State | HI
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Zip | 96814-2066
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Country | US
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Telephone | 808-593-9944
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Fax | 808-593-0565
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALLACE J MATTHEWS JR.
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Credential | M.D.
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Telephone | 808-593-9944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD4255
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License Number State | HI
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