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General NPI Number Information
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NPI Number | 1801150560
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Entity Type | Organization
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Legal Business Name | JOANNE BAUTISTA-TORRES PSYD. LLC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 119 MERCHANT ST SUITE 605
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City | HONOLULU
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State | HI
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Zip | 96813-4452
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Country | US
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Telephone | 808-646-1322
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Fax |
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Provider Business Mailing Address
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Address Line | 7192 KALANIANAOLE HWY SUITE A143A PMB159
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City | HONOLULU
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State | HI
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Zip | 96825-1800
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Country | US
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Telephone | 808-646-1322
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOANNE BAUTISTA-TORRES
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Credential | PSYD
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Telephone | 808-646-1322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-1183
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License Number State | HI
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