Provider Demographics
NPI:1770636581
Name:EASTWOOD, PRATIBHA SHULAMIT (PHD)
Entity type:Individual
Prefix:
First Name:PRATIBHA
Middle Name:SHULAMIT
Last Name:EASTWOOD
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2022
Mailing Address - Street 2:
Mailing Address - City:WHITE CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97503-0022
Mailing Address - Country:US
Mailing Address - Phone:541-234-4781
Mailing Address - Fax:
Practice Address - Street 1:1016 KAPAHULU AVE STE 265
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1318
Practice Address - Country:US
Practice Address - Phone:808-214-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY390103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI99028622496817A001OtherTRICARE
HI00B0056073OtherHMSA
HI990286224OtherTIN
HI990286224OtherTIN