Provider Demographics
NPI:1447845755
Name:PRZECIECHOWSKA, DESTINA ROJA
Entity type:Individual
Prefix:MRS
First Name:DESTINA
Middle Name:ROJA
Last Name:PRZECIECHOWSKA
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 1:810 KOKOMO RD STE 230
Mailing Address - Street 2:
Mailing Address - City:HAIKU
Mailing Address - State:HI
Mailing Address - Zip Code:96708-5072
Mailing Address - Country:US
Mailing Address - Phone:808-214-2326
Mailing Address - Fax:
Practice Address - Street 1:810 KOKOMO RD STE 230
Practice Address - Street 2:
Practice Address - City:HAIKU
Practice Address - State:HI
Practice Address - Zip Code:96708-5072
Practice Address - Country:US
Practice Address - Phone:808-214-2326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician