Healthcare Provider Details

I. General information

NPI: 1275216368
Provider Name (Legal Business Name): PLACIDA CALIBOSO MENCIAS FAMILY CAREGIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2023
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1128 KAHUAILANI ST
WAIPAHU HI
96797-3601
US

IV. Provider business mailing address

94-1128 KAHUAILANI ST
WAIPAHU HI
96797-3601
US

V. Phone/Fax

Practice location:
  • Phone: 808-692-6520
  • Fax:
Mailing address:
  • Phone: 808-692-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: