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General NPI Number Information
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NPI Number | 1093368078
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Entity Type | Individual
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Provider Name | AISHA TIERRA
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Gender | Female
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 95-732 MAIAKU ST
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City | MILILANI
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State | HI
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Zip | 96789-2816
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Country | US
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Telephone | 808-321-8105
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Fax | 808-623-6937
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Provider Business Mailing Address
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Address Line | 91-206 LOULULELO PL
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City | KAPOLEI
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State | HI
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Zip | 96707-3108
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Country | US
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Telephone | 808-294-7543
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-92036
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License Number State | HI
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