Provider Demographics
NPI:1497273858
Name:TECSON, LEO CABALLERO (LMT)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:CABALLERO
Last Name:TECSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 330303
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96733-0303
Mailing Address - Country:US
Mailing Address - Phone:808-276-3057
Mailing Address - Fax:
Practice Address - Street 1:95 LONO AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732
Practice Address - Country:US
Practice Address - Phone:808-276-3057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT3954225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist