Provider Demographics
NPI:1083256085
Name:CAPI MONTIJO, KRYSTEL
Entity Type:Individual
Prefix:
First Name:KRYSTEL
Middle Name:
Last Name:CAPI MONTIJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRYSTEL
Other - Middle Name:
Other - Last Name:CAPI ROMERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:241 LAKEVIEW DR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-3436
Mailing Address - Country:US
Mailing Address - Phone:661-941-0854
Mailing Address - Fax:
Practice Address - Street 1:241 LAKEVIEW DR UNIT 101
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-3436
Practice Address - Country:US
Practice Address - Phone:661-941-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician