Provider Demographics
NPI:1710652417
Name:DELA CRUZ, JAS RICK (RBT)
Entity Type:Individual
Prefix:
First Name:JAS RICK
Middle Name:
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 FACTORY ST APT A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4729
Mailing Address - Country:US
Mailing Address - Phone:808-492-2777
Mailing Address - Fax:
Practice Address - Street 1:915 FACTORY ST APT A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4729
Practice Address - Country:US
Practice Address - Phone:808-492-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician