Provider Demographics
NPI:1437661238
Name:BYRON CARRASCO DPM LLC
Entity Type:Organization
Organization Name:BYRON CARRASCO DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:R
Authorized Official - Last Name:CARRASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:808-366-8167
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 STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2023-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIP0-218213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty