Provider Demographics
NPI:1750254645
Name:DISCOVERY HAWAII INTERVENTIONAL PSYCHIATRY PC CORP
Entity type:Organization
Organization Name:DISCOVERY HAWAII INTERVENTIONAL PSYCHIATRY PC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:VACCARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-736-1118
Mailing Address - Street 1:3940 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204
Mailing Address - Country:US
Mailing Address - Phone:646-752-6643
Mailing Address - Fax:305-930-7437
Practice Address - Street 1:31-631 OLD MAMALAHOA HWY
Practice Address - Street 2:
Practice Address - City:HAKALAU
Practice Address - State:HI
Practice Address - Zip Code:96710
Practice Address - Country:US
Practice Address - Phone:646-752-6643
Practice Address - Fax:305-930-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty