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General NPI Number Information
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NPI Number | 1477061067
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Entity Type | Individual
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Provider Name | GINA EBATO
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Gender | Female
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 01/17/2018
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Provider Practice Location Address
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Address Line | 94-1221 KA UKA BLVD STE 108
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City | WAIPAHU
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State | HI
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Zip | 96797-6299
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Country | US
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Telephone | 808-292-7968
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Fax |
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Provider Business Mailing Address
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Address Line | 98-453 KAONOHI ST APT 3
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City | AIEA
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State | HI
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Zip | 96701-2377
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Country | US
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Telephone |
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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-15-08338
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License Number State | HI
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