Healthcare Provider Details

I. General information

NPI: 1932032547
Provider Name (Legal Business Name): CALEB ROY TUCKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 17TH ST
PASO ROBLES CA
93446-2157
US

IV. Provider business mailing address

800 NIBLICK RD
PASO ROBLES CA
93446-4858
US

V. Phone/Fax

Practice location:
  • Phone: 805-769-1350
  • Fax:
Mailing address:
  • Phone: 805-769-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240207414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: