Healthcare Provider Details

I. General information

NPI: 1497349518
Provider Name (Legal Business Name): CODY AARON MALTEZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date: 12/27/2024
Reactivation Date: 02/04/2025

III. Provider practice location address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

IV. Provider business mailing address

5722 KALANIANAOLE HWY
HONOLULU HI
96821-2388
US

V. Phone/Fax

Practice location:
  • Phone: 808-373-3555
  • Fax:
Mailing address:
  • Phone: 808-373-3555
  • Fax: 808-373-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-6058
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: