Individual
TIAYA BLUE RUGGIRELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13-3773 ALA ILI RD, PAHOA, HI 96778-2067
(907) 314-3668
Mailing address
PO BOX 2067, PAHOA, HI 96778-2067
(907) 314-3668
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9073143668
—
HI
Enumeration date
08/13/2020
Last updated
08/13/2020
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