Provider Demographics
NPI:1336811124
Name:ABABON, TYANA
Entity Type:Individual
Prefix:
First Name:TYANA
Middle Name:
Last Name:ABABON
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 1:2404 HOOHOIHOI ST
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1649
Mailing Address - Country:US
Mailing Address - Phone:808-397-6026
Mailing Address - Fax:
Practice Address - Street 1:2404 HOOHOIHOI ST
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-1649
Practice Address - Country:US
Practice Address - Phone:808-397-6026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician