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General NPI Number Information
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NPI Number | 1386988616
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERANS AFFAIRS
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 11/27/2012
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Provider Practice Location Address
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Address Line | 459 PATTERSON RD
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City | HONOLULU
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State | HI
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Zip | 96819-1522
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Country | US
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Telephone | 808-433-0357
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Fax |
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Provider Business Mailing Address
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Address Line | 459 PATTERSON RD
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City | HONOLULU
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State | HI
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Zip | 96819-1522
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Country | US
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Telephone | 808-433-0357
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Fax |
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Authorized Official
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Title or Position | AO, MHS
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Name | TINY PARK
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Credential |
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Telephone | 808-433-0676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 32606
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License Number State | CA
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