Provider Demographics
NPI:1134978562
Name:RIBAC, JASMINE MIKAYLA
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MIKAYLA
Last Name:RIBAC
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 1:91-523 KUHIALOKO ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4517
Mailing Address - Country:US
Mailing Address - Phone:808-292-2583
Mailing Address - Fax:
Practice Address - Street 1:91-523 KUHIALOKO ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-4517
Practice Address - Country:US
Practice Address - Phone:808-292-2583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician