=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881402725
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE MANUEL RAMOS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2024
-----------------------------------------------------
Last Update Date | 12/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94-539 PUAHI ST
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-6200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-591-6060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41-363 SADDLE CITY RD UNIT 9
-----------------------------------------------------
City | WAIMANALO
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96795-1156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-853-7731
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number | RBT-24-400473
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------