Raymond Lacbain Credo, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

480 Central Ave
Pearl Harbor, HI 96860-4908

Phone

(808) 474-4242

NPI assigned

Aug 17, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1660694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1396463261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 CENTRAL AVE",
            "city": "PEARL HARBOR",
            "state": "HI",
            "postal_code": "968604908",
            "telephone_number": "808-474-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 CENTRAL AVE",
            "city": "PEARL HARBOR",
            "state": "HI",
            "postal_code": "968604908",
            "telephone_number": "808-474-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREDO",
        "first_name": "RAYMOND",
        "middle_name": "LACBAIN",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-17",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joan Eula Flormata Conde, RN
• Richard Ryan Conkle, D.D.S.
• Manuel Contreras Jr., IDC
• Amy Lynn Coston, RN
• Caroline Marie Crandall, RN
• Jesus Manuel Crespo-Diaz, AHCNS, ACNP-BC
• Rachele A Cruz, RN
• Raynier Cruzborroto, PA-C
• Tyler Godbee Cuchens, LPN
• Kelis Daionia Cummings, LPN

• All providers in Pearl Harbor, HI
• Independent Duty Corpsman in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.