Provider Demographics
NPI:1700847274
Name:THE PACIFIC INSTITUTE OF HUMAN RESTORATION LLC
Entity Type:Organization
Organization Name:THE PACIFIC INSTITUTE OF HUMAN RESTORATION LLC
Other - Org Name:HONNEBIER MARIA B
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:HONNEBIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-523-9363
Mailing Address - Street 1:820 MILILANI ST
Mailing Address - Street 2:STE 702A
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-523-9363
Mailing Address - Fax:808-523-9418
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:STE 709
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-523-5033
Practice Address - Fax:808-528-4713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11371208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000254102OtherHMSA
HIH100664Medicare ID - Type Unspecified