Provider Demographics
NPI:1629894274
Name:GUERRERO, ASPEN
Entity type:Individual
Prefix:
First Name:ASPEN
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASPEN
Other - Middle Name:
Other - Last Name:VARELA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:91-215 PAIAHA PL
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-3125
Mailing Address - Country:US
Mailing Address - Phone:559-491-7755
Mailing Address - Fax:
Practice Address - Street 1:420 WAIAKAMILO RD STE 202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4950
Practice Address - Country:US
Practice Address - Phone:808-845-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI24-395523106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician