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General NPI Number Information
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NPI Number | 1144403056
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Entity Type | Organization
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Legal Business Name | KEVIN E CALVO
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Dates
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Enumeration Date | 12/13/2007
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 3737 MORAGA AVE STE B107
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City | SAN DIEGO
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State | CA
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Zip | 92117-5300
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Country | US
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Telephone | 858-270-9972
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Fax | 858-270-6560
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Provider Business Mailing Address
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Address Line | 3737 MORAGA AVE STE B107
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City | SAN DIEGO
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State | CA
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Zip | 92117-5300
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Country | US
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Telephone | 858-270-9972
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Fax | 858-270-6560
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Authorized Official
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Title or Position | PRACTITIONER/OWNER
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Name | MR. KEVIN EDWARD CALVO
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Credential | CPO, FAAOP
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Telephone | 858-270-9972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | 1242
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License Number State | CA
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