Basic Information
| Provider Information | |||||||||
| NPI: | 1770736704 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PACIFIC AUTISM CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 AUAHI STREET | ||||||||
| Address2: | SUITE A6 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085238188 | ||||||||
| FaxNumber: | 8085231687 | ||||||||
| Practice Location | |||||||||
| Address1: | 670 AUAHI ST | ||||||||
| Address2: | SUITE A6 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968135136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085238188 | ||||||||
| FaxNumber: | 8085231687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2008 | ||||||||
| LastUpdateDate: | 02/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | KNOTT | ||||||||
| AuthorizedOfficialFirstName: | TRAVIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8085238188 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.