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General NPI Number Information
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NPI Number | 1336529742
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Entity Type | Organization
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Legal Business Name | REVOLUTION ABA LLC
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Dates
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Enumeration Date | 06/02/2015
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 200 N VINEYARD BLVD STE A325 #5429
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City | HONOLULU
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State | HI
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Zip | 96817
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Country | US
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Telephone | 808-207-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 200 N VINEYARD BLVD STE A325 #5429
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City | HONOLULU
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State | HI
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Zip | 96817
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Country | US
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Telephone | 808-207-5272
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | BREANN GONZALEZ
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Credential | BCBA
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Telephone | 720-982-7888
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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 | 1-14-15946
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License Number State | CO
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