Provider Demographics
NPI:1407197767
Name:QUEENS MEDICAL CENTER
Entity type:Organization
Organization Name:QUEENS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:SANCHEZ
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:808-691-7103
Mailing Address - Street 1:1374 NUUANU AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4032
Mailing Address - Country:US
Mailing Address - Phone:808-691-7103
Mailing Address - Fax:808-691-4574
Practice Address - Street 1:1374 NUUANU AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4032
Practice Address - Country:US
Practice Address - Phone:808-691-7103
Practice Address - Fax:808-691-4574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI3345283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital