Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1242 | CA |
N | 222Z00000X | Podiatrist | 1242 | CA |
N | 224P00000X | Prosthetist | 1242 | CA |
Y | 225000000X | Orthotic Fitter | 1242 | CA |
N | 225400000X | Rehabilitation Practitioner | 1242 | CA |
NPI | 1679675003 |
---|---|
Provider Name | Mr. Kevin E Calvo |
First Address | San Diego, CA 92117-5404 |
Second Address | San Diego, CA 92117-5404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 18/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
XC0012490 | (05) | CA |