Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician | RBT-17-33746 | HI |
NPI | 1003343716 |
---|---|
Provider Name | Kimberly Baloran |
First Address | Aiea, HI 96701-3278 |
Second Address | Aiea, HI 96701-3278 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2017 |
Last Update Date | 12/05/2017 |