Provider Demographics
NPI:1235419458
Name:GAYLE HOSTETTER PH.D., LLC
Entity Type:Organization
Organization Name:GAYLE HOSTETTER PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYHCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-497-1759
Mailing Address - Street 1:1188 BISHOP ST
Mailing Address - Street 2:SUITE 3509
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3301
Mailing Address - Country:US
Mailing Address - Phone:808-497-1759
Mailing Address - Fax:808-922-8262
Practice Address - Street 1:1188 BISHOP ST
Practice Address - Street 2:SUITE 3509
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-3301
Practice Address - Country:US
Practice Address - Phone:808-497-1759
Practice Address - Fax:808-922-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY638103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty