Provider Demographics
NPI:1669195533
Name:BOQUER-VELASCO, JADE PENELOPE
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:PENELOPE
Last Name:BOQUER-VELASCO
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 1:91-213 HANAPOULI CIR APT D
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3746
Mailing Address - Country:US
Mailing Address - Phone:808-931-0135
Mailing Address - Fax:
Practice Address - Street 1:91-213 HANAPOULI CIR APT D
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3746
Practice Address - Country:US
Practice Address - Phone:808-931-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-22-234258106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician