Basic Information
| Provider Information | |||||||||
| NPI: | 1831765395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERSANDO | ||||||||
| FirstName: | JAMES CALEB | ||||||||
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| Credential: | ATP, NRP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3164 CALAMONDIN WAY | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968181411 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1253 MAKALAPA GATE RD BLDG 1407 | ||||||||
| Address2: | |||||||||
| City: | JBPHH | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968604479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084731880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2021 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146L00000X | N | Emergency Medical Service Providers | Emergency Medical Technician, Paramedic | 171000000X | Y | Other Service Providers | Military Health Care Provider |
No ID Information.