Healthcare Provider Details

I. General information

NPI: 1851121982
Provider Name (Legal Business Name): CALEB MICHEAL IRVIN RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1031
PEPEEKEO HI
96783-1031
US

IV. Provider business mailing address

PO BOX 1031
PEPEEKEO HI
96783-1031
US

V. Phone/Fax

Practice location:
  • Phone: 541-206-0019
  • Fax:
Mailing address:
  • Phone: 541-206-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: