Provider Demographics
NPI:1679095822
Name:MASUDA, CALEB P (MS)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:P
Last Name:MASUDA
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 SKYLINE CT
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5441
Mailing Address - Country:US
Mailing Address - Phone:408-206-7435
Mailing Address - Fax:
Practice Address - Street 1:1108 CORKER ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6512
Practice Address - Country:US
Practice Address - Phone:530-303-8245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17564171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty