Provider Demographics
NPI:1518687664
Name:SUTTER HEALTH PACIFIC
Entity Type:Organization
Organization Name:SUTTER HEALTH PACIFIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:LI
Authorized Official - Last Name:SANTIAGO-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-677-2587
Mailing Address - Street 1:91-2301 OLD FT WEAVER RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3602
Mailing Address - Country:US
Mailing Address - Phone:808-677-2587
Mailing Address - Fax:808-677-2592
Practice Address - Street 1:91-2301 OLD FT WEAVER RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3602
Practice Address - Country:US
Practice Address - Phone:808-677-2587
Practice Address - Fax:808-677-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI503004Medicaid