Provider Demographics
NPI:1861173478
Name:CALIBUYOT, FERNANDO A JR
Entity type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:A
Last Name:CALIBUYOT
Suffix:JR
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 1:91-1001 KEAUNUI DR UNIT 106
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-6325
Mailing Address - Country:US
Mailing Address - Phone:808-387-4878
Mailing Address - Fax:
Practice Address - Street 1:91-1001 KEAUNUI DR UNIT 106
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6325
Practice Address - Country:US
Practice Address - Phone:808-387-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIGE-046-731-4176-01343900000X
HI343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)