Provider Demographics
NPI:1063133643
Name:MIND WELLNESS HAWAII
Entity type:Organization
Organization Name:MIND WELLNESS HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ALARCON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:619-471-7596
Mailing Address - Street 1:PO BOX 700765
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96709-0765
Mailing Address - Country:US
Mailing Address - Phone:808-852-0433
Mailing Address - Fax:
Practice Address - Street 1:1003 BISHOP ST STE 2700
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-6475
Practice Address - Country:US
Practice Address - Phone:808-852-0433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty