Provider Demographics
NPI:1508511874
Name:IWATA, JARIN TSUYOSHI
Entity Type:Individual
Prefix:
First Name:JARIN
Middle Name:TSUYOSHI
Last Name:IWATA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 ALA MOANA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4262
Mailing Address - Country:US
Mailing Address - Phone:808-585-1424
Mailing Address - Fax:
Practice Address - Street 1:91-978 PILIOKAHE PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-4000
Practice Address - Country:US
Practice Address - Phone:808-349-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst