Provider Demographics
NPI:1114192770
Name:SPAIN, BERTRAM KALANI (PHD)
Entity Type:Individual
Prefix:
First Name:BERTRAM
Middle Name:KALANI
Last Name:SPAIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 WAIANUENUE AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2489
Mailing Address - Country:US
Mailing Address - Phone:808-961-7015
Mailing Address - Fax:808-961-7099
Practice Address - Street 1:214 WAIANUENUE AVE STE 209
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2489
Practice Address - Country:US
Practice Address - Phone:808-961-7015
Practice Address - Fax:808-961-7099
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker