Provider Demographics
NPI:1194830794
Name:ACADEMY FOOT CENTER OF HAWAII, INC.
Entity Type:Organization
Organization Name:ACADEMY FOOT CENTER OF HAWAII, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PASCUAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-536-4335
Mailing Address - Street 1:1329 LUSITANA ST STE 801
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2434
Mailing Address - Country:US
Mailing Address - Phone:808-536-4335
Mailing Address - Fax:808-537-9195
Practice Address - Street 1:1329 LUSITANA ST STE 801
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2434
Practice Address - Country:US
Practice Address - Phone:808-536-4335
Practice Address - Fax:808-537-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI502527Medicaid
HI=========OtherFEDERAL TAX ID #