Individual
MARVIN JAKE CORTADO DE PERALTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
3060 EIWA ST, LIHUE, HI 96766-1310
(808) 274-3500
Mailing address
3060 EIWA ST, LIHUE, HI 96766-1310
(808) 274-3500
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-7522-430126
HI
Other
Enumeration date
12/19/2022
Last updated
12/19/2022
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