Healthcare Provider Details

I. General information

NPI: 1679675003
Provider Name (Legal Business Name): KEVIN E CALVO CPO FAAOP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 MORAGA AVE STE B 107
SAN DIEGO CA
92117-5404
US

IV. Provider business mailing address

3737 MORAGA AVE STE B 107
SAN DIEGO CA
92117-5404
US

V. Phone/Fax

Practice location:
  • Phone: 858-270-9972
  • Fax: 858-270-6560
Mailing address:
  • Phone: 858-270-9972
  • Fax: 858-270-6560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number1242
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number1242
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number1242
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number1242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: