MEDICARE: WHITNEY SACREMENTO RBT

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	:	1639908114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY SACREMENTO RBT

Provider Business Mailing Address
First Line	:	1367 S KIHEI RD UNIT 3203
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-5802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1367 S KIHEI RD UNIT 3203
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-5802
Country	:	US
Telephone Number	:	530-400-2326
Fax Number	:

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

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	07/31/2024

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Directions to “ WHITNEY SACREMENTO RBT” Practice Location

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