Provider Demographics
NPI:1679229652
Name:CAYCO, BEVERLY DIRIGE (RD)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:DIRIGE
Last Name:CAYCO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 DILLINGHAM BLVD APT 214
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4854
Mailing Address - Country:US
Mailing Address - Phone:808-754-2072
Mailing Address - Fax:
Practice Address - Street 1:1514 DILLINGHAM BLVD APT 214
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4854
Practice Address - Country:US
Practice Address - Phone:808-754-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty