Healthcare Provider Details

I. General information

NPI: 1356275192
Provider Name (Legal Business Name): CALEB EDGER MASIH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 E RINCON ST STE 209
CORONA CA
92879-1379
US

IV. Provider business mailing address

495 E RINCON ST
CORONA CA
92879-1366
US

V. Phone/Fax

Practice location:
  • Phone: 562-821-1491
  • Fax:
Mailing address:
  • Phone: 562-821-1491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: