Provider Demographics
NPI:1356641476
Name:CARRASCO, BYRON (DPM)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:
Last Name:CARRASCO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46-036 KAMEHAMEHA HWY
Mailing Address - Street 2:1099
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-9998
Mailing Address - Country:US
Mailing Address - Phone:808-366-8167
Mailing Address - Fax:844-380-3612
Practice Address - Street 1:94-216 FARRINGTON HWY # A103
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1922
Practice Address - Country:US
Practice Address - Phone:808-366-8167
Practice Address - Fax:855-437-1594
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPO 218213ES0103X
CAE4978213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery