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Organization
HEALTH FACILITY LABORATORY
Active
Organization
HEALTH FACILITY LABORATORY
Active
Other names
Ultra Lab Test
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB CORNELIUS PARKER (SPECIALIST TECHNOLOGIST)
(601) 329-1321
Entity
Organization
Contact information
Practice address
229 PAOAKALANI AVE # 714, HONOLULU, HI 96815-3764
(907) 786-4401
Mailing address
229 PAOAKALANI AVE # 714, HONOLULU, HI 96815-3764
(601) 329-1321
Taxonomy
Speciality
Code
Description
License number
State
103TP0814X
Psychoanalysis Psychologist
—
NULL
103TP0814X
Psychoanalysis Psychologist
—
—
246Z00000X
Other Specialist/Technologist
—
NULL
246Z00000X
Other Specialist/Technologist
—
—
261QS1000X
Student Health Clinic/Center
—
NULL
293D00000X
Physiological Laboratory
Primary
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314125401722
—
MS
Enumeration date
02/23/2019
Last updated
11/11/2025
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