Individual
MR. JEREMY JACOB QUENGA I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
91-1180 MIDWAY RD, KAPOLEI, HI 96707
(808) 682-5496
Mailing address
91-1215 KANEANA ST # 13B, EWA BEACH, HI 96706-4737
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
BACB315759
HI
106S00000X
Behavior Technician
—
—
Other
Enumeration date
01/18/2020
Last updated
01/18/2020
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