Provider Demographics
NPI:1336335918
Name:PRATIBHA S. EASTWOOD, PHD, INC.
Entity Type:Organization
Organization Name:PRATIBHA S. EASTWOOD, PHD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHD
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATIBHA
Authorized Official - Middle Name:SHULAMIT
Authorized Official - Last Name:EASTWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:808-214-9253
Mailing Address - Street 1:P.O. BOX 282
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744
Mailing Address - Country:US
Mailing Address - Phone:808-214-9253
Mailing Address - Fax:808-988-7645
Practice Address - Street 1:1016 KAPAHULU AVENUE, #265
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816
Practice Address - Country:US
Practice Address - Phone:808-214-9253
Practice Address - Fax:808-988-7645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH113829Medicaid