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
—
—
246Z00000X
Other Specialist/Technologist
—
—
261QS1000X
Student Health Clinic/Center
—
—
293D00000X
Physiological Laboratory
Primary
—
—
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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