Provider Demographics
NPI:1265575377
Name:CALLO, RICK C
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:C
Last Name:CALLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-385 HAMAU ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-4506
Mailing Address - Country:US
Mailing Address - Phone:808-671-3552
Mailing Address - Fax:808-671-3552
Practice Address - Street 1:94-385 HAMAU ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-4506
Practice Address - Country:US
Practice Address - Phone:808-671-3552
Practice Address - Fax:808-671-3552
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI563298-01171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI563298-01OtherRACCP PROVIDER