Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | HI |
NPI | 1003306341 |
---|---|
Provider Name | Crystal Pena |
First Address | Honolulu, HI 96818-3172 |
Second Address | Honolulu, HI 96822-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2018 |
Last Update Date | 11/05/2018 |