Provider Demographics
NPI:1104379536
Name:CPC HAWAII LIFE CENTER LLC
Entity Type:Organization
Organization Name:CPC HAWAII LIFE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PASQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:808-945-5433
Mailing Address - Street 1:1330 ALA MOANA BLVD
Mailing Address - Street 2:UNIT 9
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4200
Mailing Address - Country:US
Mailing Address - Phone:808-945-5433
Mailing Address - Fax:808-380-1465
Practice Address - Street 1:1330 ALA MOANA BLVD
Practice Address - Street 2:UNIT 9
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4200
Practice Address - Country:US
Practice Address - Phone:808-945-5433
Practice Address - Fax:808-380-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RS0010X
HIDOS696208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty