Provider Demographics
NPI:1871269621
Name:AUTISM SPECIALISTS OF THE PACIFIC
Entity Type:Organization
Organization Name:AUTISM SPECIALISTS OF THE PACIFIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLER RIMM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-572-4500
Mailing Address - Street 1:1043 MAKAWAO AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-9468
Mailing Address - Country:US
Mailing Address - Phone:808-572-4500
Mailing Address - Fax:808-442-1050
Practice Address - Street 1:1043 MAKAWAO AVE STE 201
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-9468
Practice Address - Country:US
Practice Address - Phone:808-572-4500
Practice Address - Fax:808-442-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty