Provider Demographics
NPI:1962055491
Name:AZZALINA, JEFFREY DAVID
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DAVID
Last Name:AZZALINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 KEAHOLE PL APT 3505
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3425
Mailing Address - Country:US
Mailing Address - Phone:808-200-5134
Mailing Address - Fax:
Practice Address - Street 1:1 KEAHOLE PL APT 3505
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-3425
Practice Address - Country:US
Practice Address - Phone:808-200-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2021-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician