Basic Information
| Provider Information | |||||||||
| NPI: | 1952974867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANMUTHU | ||||||||
| FirstName: | MADHUKA | ||||||||
| MiddleName: | PIYUMALI | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA, LBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 993 | ||||||||
| Address2: | |||||||||
| City: | KAPAA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967460993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057950621 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3-3122 KUHIO HWY STE A15 | ||||||||
| Address2: | |||||||||
| City: | LIHUE | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967661157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8082469102 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2021 | ||||||||
| LastUpdateDate: | 07/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 07/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | BA-554 | HI | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.