Healthcare Provider Details

I. General information

NPI: 1063294494
Provider Name (Legal Business Name): CALEB MICHAEL MCCARTY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 10/19/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 KAPAA QUARRY PL #5002
KAILUA HI
96734
US

IV. Provider business mailing address

203 KAPAA QUARRY PL #5002
KAILUA HI
96734
US

V. Phone/Fax

Practice location:
  • Phone: 808-247-2973
  • Fax:
Mailing address:
  • Phone: 808-247-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number23-286965
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: