Provider Demographics
NPI:1215490412
Name:CARRANZA, JASON V (BOCPD)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:V
Last Name:CARRANZA
Suffix:
Gender:M
Credentials:BOCPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1042 KALOI PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3776
Mailing Address - Country:US
Mailing Address - Phone:808-397-7515
Mailing Address - Fax:
Practice Address - Street 1:1 JARRETT WHITE RD RM 3G812
Practice Address - Street 2:
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIC51722224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist