Provider Demographics
NPI:1760183859
Name:SILVA, ERNEST KANUI
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:KANUI
Last Name:SILVA
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 1:1050 W 100 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2508
Mailing Address - Country:US
Mailing Address - Phone:801-874-0030
Mailing Address - Fax:
Practice Address - Street 1:1050 W 100 N
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-2508
Practice Address - Country:US
Practice Address - Phone:801-874-0030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician