MEDICARE: JASLYN MADRIAGA-AGUIGUI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1124691571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASLYN MADRIAGA-AGUIGUI

Provider Business Mailing Address
First Line	:	99-149 KOHOMUA ST APT 22E
Second Line	:
City	:	AIEA
State	:	HI
Zip	:	96701-3720
Country	:	US
Telephone Number	:	808-393-0499
Fax Number	:

Provider Business Practice Location Address
First Line	:	1147 KUMANO ST
Second Line	:
City	:	PEARL CITY
State	:	HI
Zip	:	96782-1579
Country	:	US
Telephone Number	:	808-307-5300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2021
Last Update Date	:	07/22/2021

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