Provider Demographics
NPI:1265316467
Name:MAUNAKEA, LISSETTE
Entity type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:MAUNAKEA
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 1:3600 SISK RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-0535
Mailing Address - Country:US
Mailing Address - Phone:209-646-9951
Mailing Address - Fax:
Practice Address - Street 1:3600 SISK RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-0535
Practice Address - Country:US
Practice Address - Phone:209-646-9951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-12-03
Deactivation Date:2025-10-30
Deactivation Code:
Reactivation Date:2025-12-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician