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General NPI Number Information
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NPI Number | 1598965253
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Entity Type | Organization
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Legal Business Name | PACIFIC CLINIC, INC.
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 4566 OHIA ST
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City | KAPAA
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State | HI
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Zip | 96746-1646
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Country | US
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Telephone | 808-822-5881
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Fax | 808-823-6535
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Provider Business Mailing Address
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Address Line | 4-1191 KUHIO HWY #289
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City | KAPAA
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State | HI
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Zip | 96746-1674
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Country | US
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Telephone | 808-822-5881
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Fax | 808-823-6535
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Authorized Official
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Title or Position | PHD/OWNER
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Name | DR. ROBERT J BROWN
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Credential | PHD
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Telephone | 808-822-5881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY-433
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License Number State | HI
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