Provider Demographics
NPI:1487202180
Name:PEREZ JENSEN, JULIA MICHELLE
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:MICHELLE
Last Name:PEREZ JENSEN
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 1:95-227 WAIKALANI DR APT A1001
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-3540
Mailing Address - Country:US
Mailing Address - Phone:435-773-1118
Mailing Address - Fax:
Practice Address - Street 1:100 KAHELU AVE STE 112
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-3913
Practice Address - Country:US
Practice Address - Phone:808-625-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
HIBA-548103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician