Provider Demographics
NPI:1770028144
Name:TRUJILLO SISEMORE, NANCY (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:TRUJILLO SISEMORE
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:610 ALA MOANA BLVD
Mailing Address - Street 2:UNIT M411
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4901
Mailing Address - Country:US
Mailing Address - Phone:714-392-1304
Mailing Address - Fax:
Practice Address - Street 1:610 ALA MOANA BLVD
Practice Address - Street 2:UNIT M411
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4901
Practice Address - Country:US
Practice Address - Phone:714-392-1304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA 170103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst