Provider Demographics
NPI:1093470932
Name:CALAMBACAN, ISSOBELLE NICOLE BARANGAN (RBT)
Entity Type:Individual
Prefix:MISS
First Name:ISSOBELLE NICOLE
Middle Name:BARANGAN
Last Name:CALAMBACAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1024 KOMOAINA ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5906
Mailing Address - Country:US
Mailing Address - Phone:808-421-9654
Mailing Address - Fax:
Practice Address - Street 1:91-740 PAPIPI RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2436
Practice Address - Country:US
Practice Address - Phone:808-307-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
HI691568106S00000X
HIBACB691568106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician