Basic Information
| Provider Information | |||||||||
| NPI: | 1588158547 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PACHECO | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | MAHEALANI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 91-114 HAIEA PL | ||||||||
| Address2: | |||||||||
| City: | EWA BEACH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967063952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8087536431 | ||||||||
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| Practice Location | |||||||||
| Address1: | 203 KAPAA QUARRY PL. | ||||||||
| Address2: | |||||||||
| City: | KAILUA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082472973 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2018 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BA-606-0 | HI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst | 106S00000X | N | 106E00000X | N |
No ID Information.