Provider Demographics
NPI:1679675003
Name:CALVO, KEVIN E (CPO FAAOP)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:E
Last Name:CALVO
Suffix:
Gender:M
Credentials:CPO FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MORAGA AVE
Mailing Address - Street 2:STE B 107
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5404
Mailing Address - Country:US
Mailing Address - Phone:858-270-9972
Mailing Address - Fax:858-270-6560
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:STE B 107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5404
Practice Address - Country:US
Practice Address - Phone:858-270-9972
Practice Address - Fax:858-270-6560
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1242222Z00000X, 224P00000X, 225000000X, 225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXC0012490Medicaid
CAXC0012490Medicaid