MEDICARE: JAQUELINE ELA HERNANDEZ

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	:	1841982741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAQUELINE ELA HERNANDEZ

Provider Business Mailing Address
First Line	:	155 HALL ST UNIT 101
Second Line	:
City	:	WAHIAWA
State	:	HI
Zip	:	96786-6343
Country	:	US
Telephone Number	:	321-208-3410
Fax Number	:

Provider Business Practice Location Address
First Line	:	1448 LILIHA ST
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96817-3589
Country	:	US
Telephone Number	:	321-208-3410
Fax Number	:

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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Directions to “ JAQUELINE ELA HERNANDEZ ” Practice Location

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