Provider Demographics
NPI:1235827635
Name:ULANDEZ, KSIZLE
Entity Type:Individual
Prefix:
First Name:KSIZLE
Middle Name:
Last Name:ULANDEZ
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 1:94-706 KAAOKI PL
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1211
Mailing Address - Country:US
Mailing Address - Phone:808-200-7681
Mailing Address - Fax:
Practice Address - Street 1:94-706 KAAOKI PL
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1211
Practice Address - Country:US
Practice Address - Phone:808-200-7681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HII-220095253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency