Provider Demographics
NPI:1053759217
Name:REID, CALEB MAUTI (DNP, MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:MAUTI
Last Name:REID
Suffix:
Gender:
Credentials:DNP, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E COMMERCIAL RD
Mailing Address - Street 2:112
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-5212
Mailing Address - Country:US
Mailing Address - Phone:480-999-8295
Mailing Address - Fax:480-800-2212
Practice Address - Street 1:350 E COMMERCIAL RD STE 112
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3763
Practice Address - Country:US
Practice Address - Phone:909-913-0674
Practice Address - Fax:480-800-2212
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10031832363LP0808X
COC-APN.0103095-C-NP363LP0808X
TX1098621363LP0808X
CANP95023143363LP0808X, 163WP0808X, 363LP0808X
AZNP279741363LP0808X
NM70411363LP0808X
AZ279741363LP0808X, 2084A0401X, 2083A0300X
CA95023143363LF0000X
WAAP61372139363LP0808X
CA726417163WP0808X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty