Provider Demographics
NPI:1225318454
Name:PACIFIC NEUROPSYCHOLOGY SERVICES
Entity Type:Organization
Organization Name:PACIFIC NEUROPSYCHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-599-7676
Mailing Address - Street 1:PO BOX 3805
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96812-3805
Mailing Address - Country:US
Mailing Address - Phone:808-599-7676
Mailing Address - Fax:808-599-7900
Practice Address - Street 1:438 HOBRON LN STE 409
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1229
Practice Address - Country:US
Practice Address - Phone:808-599-7676
Practice Address - Fax:808-599-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1157103G00000X, 103T00000X, 103TC0700X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty