Provider Demographics
NPI:1225101710
Name:PANGILINAN, RENEE K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:K
Last Name:PANGILINAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S KING ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3154
Mailing Address - Country:US
Mailing Address - Phone:808-949-1555
Mailing Address - Fax:808-949-1554
Practice Address - Street 1:2525 S KING ST
Practice Address - Street 2:SUITE 311
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3154
Practice Address - Country:US
Practice Address - Phone:808-949-1555
Practice Address - Fax:808-949-1554
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY872103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI564212Medicaid
HI564212Medicaid