Provider Demographics
NPI:1164265070
Name:AVIGUETERO, SHARLA
Entity type:Individual
Prefix:
First Name:SHARLA
Middle Name:
Last Name:AVIGUETERO
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:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:WAIMEA
Mailing Address - State:HI
Mailing Address - Zip Code:96796-0267
Mailing Address - Country:US
Mailing Address - Phone:808-639-0758
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 38
Practice Address - Street 2:
Practice Address - City:ELEELE
Practice Address - State:HI
Practice Address - Zip Code:96705-0038
Practice Address - Country:US
Practice Address - Phone:808-335-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician