Provider Demographics
NPI:1154067577
Name:ABITAGO, JOLINA ANNE
Entity Type:Individual
Prefix:
First Name:JOLINA ANNE
Middle Name:
Last Name:ABITAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 CANYON MIST CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-9530
Mailing Address - Country:US
Mailing Address - Phone:808-657-1075
Mailing Address - Fax:
Practice Address - Street 1:373 CANYON MIST CT
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-9530
Practice Address - Country:US
Practice Address - Phone:808-657-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician