Individual
MR. JACOB ONTIVEROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
68-3502 KAPII PL., WAIKOLOA, HI 96738
(808) 937-8741
Mailing address
PO BOX 383733, WAIKOLOA, HI 96738-3733
(808) 937-8741
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
24-335349
HI
Other
Enumeration date
04/25/2024
Last updated
04/25/2024
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