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General NPI Number Information
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NPI Number | 1184347411
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Entity Type | Individual
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Provider Name | SHANA KRISTINE IKEDA VALENZUELA BACB 1-21-49139
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Gender | Female
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Dates
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Enumeration Date | 09/21/2022
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Last Update Date | 06/19/2023
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Provider Practice Location Address
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Address Line | 825 MANZELMAN CIR
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City | HONOLULU
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State | HI
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Zip | 96818-4733
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Country | US
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Telephone | 808-307-4630
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Fax |
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Provider Business Mailing Address
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Address Line | 2914 ALA PILI PL
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City | HONOLULU
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State | HI
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Zip | 96818-1624
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Country | US
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Telephone | 808-216-4476
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BA533
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License Number State | HI
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