Individual
MISS JACEY KEIANA FERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
564 SOUTH ST, HONOLULU, HI 96813-5013
(808) 591-1173
(808) 591-1174
Mailing address
502 KEAWE ST APT 616, HONOLULU, HI 96813-3165
(209) 894-5474
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-22-240744
HI
Other
Enumeration date
11/17/2022
Last updated
11/22/2022
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