Individual
BRYANT GIVENS VERGARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
550 KUNEHI ST APT 205, KAPOLEI, HI 96707-2069
(808) 780-0014
Mailing address
99-260 AIEA HEIGHTS DR, AIEA, HI 96701-3937
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
HI
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
HI
Enumeration date
09/07/2017
Last updated
09/07/2017
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