Provider Demographics
NPI:1144673625
Name:BRISTOL, ROXANNE MICHEL (BCBA)
Entity type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:MICHEL
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:MICHEL
Other - Last Name:REGALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:94-820 LUMIAUAU ST
Mailing Address - Street 2:APT D101
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4859
Mailing Address - Country:US
Mailing Address - Phone:714-213-9271
Mailing Address - Fax:
Practice Address - Street 1:94-820 LUMIAUAU ST APT D101
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-6801
Practice Address - Country:US
Practice Address - Phone:714-213-9271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIBA139103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst