Healthcare Provider Details

I. General information

NPI: 1720997448
Provider Name (Legal Business Name): JAZMINE GONZALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 HULI RD
KILAUEA HI
96754-5565
US

IV. Provider business mailing address

92-6046 NEMO ST
KAPOLEI HI
96707-2813
US

V. Phone/Fax

Practice location:
  • Phone: 808-292-7964
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT262847842
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: