Healthcare Provider Details

I. General information

NPI: 1851926240
Provider Name (Legal Business Name): DUSTIN PLATTER BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 10/21/2020
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD STE 7-400
HONOLULU HI
96813-4902
US

IV. Provider business mailing address

77-347 EMALIA PL
KAILUA KONA HI
96740-9727
US

V. Phone/Fax

Practice location:
  • Phone: 808-354-0910
  • Fax:
Mailing address:
  • Phone: 928-208-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBA-372
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: