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General NPI Number Information
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NPI Number | 1770028144
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Entity Type | Individual
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Provider Name | NANCY TRUJILLO SISEMORE M.S., BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 12/21/2016
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | NAVAL BASE GUAM
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City | FPO
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State | AP
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Zip | 96540
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Country | US
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Telephone | 714-392-1304
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Fax |
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Provider Business Mailing Address
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Address Line | 1 NEW ST
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City | SANTA RITA
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State | GU
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Zip | 96915-1168
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Country | US
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Telephone | 714-392-1304
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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 | BA 170
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License Number State | HI
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