Provider Demographics
NPI:1184208951
Name:PACATANG, JELAH
Entity Type:Individual
Prefix:
First Name:JELAH
Middle Name:
Last Name:PACATANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2975 ALA NAPUAA PL APT 301
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-2739
Mailing Address - Country:US
Mailing Address - Phone:808-452-4335
Mailing Address - Fax:
Practice Address - Street 1:4510 SALT LAKE BLVD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3153
Practice Address - Country:US
Practice Address - Phone:808-597-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician