Provider Demographics
NPI:1497349518
Name:MALTEZO, CODY AARON
Entity type:Individual
Prefix:
First Name:CODY AARON
Middle Name:
Last Name:MALTEZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5722 KALANIANAOLE HWY
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2388
Mailing Address - Country:US
Mailing Address - Phone:808-373-3555
Mailing Address - Fax:808-373-3666
Practice Address - Street 1:5722 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-2388
Practice Address - Country:US
Practice Address - Phone:808-373-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2025-02-13
Deactivation Date:2024-12-27
Deactivation Code:
Reactivation Date:2025-02-04
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 225100000X
HIPT-6058225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician