Healthcare Provider Details
I. General information
NPI: 1053759217
Provider Name (Legal Business Name): CALEB MAUTI REID DNP, MSN, PMHNP-BC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 06/10/2013
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
350 E COMMERCIAL RD STE 112
SAN BERNARDINO CA
92408-3763
US
IV. Provider business mailing address
350 E COMMERCIAL RD 112
SAN BERNARDINO CA
92408-5212
US
V. Phone/Fax
- Phone: 909-913-0600
- Fax: 480-800-2200
- Phone: 480-999-8200
- Fax: 480-800-2212
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0808X |
| Taxonomy | Psychiatric/Mental Health Registered Nurse |
| License Number | 726417 |
| License Number State | CA |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WP0808X |
| Taxonomy | Psychiatric/Mental Health Registered Nurse |
| License Number | NP95023143 |
| License Number State | CA |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WW0000X |
| Taxonomy | Wound Care Registered Nurse |
| License Number | 726417 |
| License Number State | CA |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2083A0300X |
| Taxonomy | Addiction Medicine (Preventive Medicine) Physician |
| License Number | 279741 |
| License Number State | AZ |
| # 5 | |
| Primary Taxonomy | N |
| Taxonomy Code | 2084A0401X |
| Taxonomy | Addiction Medicine (Psychiatry & Neurology) Physician |
| License Number | 279741 |
| License Number State | AZ |
| # 6 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 95023143 |
| License Number State | CA |
| # 7 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 10031832 |
| License Number State | OR |
| # 8 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | C-APN.0103095-C-NP |
| License Number State | CO |
| # 9 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 1098621 |
| License Number State | TX |
| # 10 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | NP279741 |
| License Number State | AZ |
| # 11 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 70411 |
| License Number State | NM |
| # 12 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | 279741 |
| License Number State | AZ |
| # 13 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | AP61372139 |
| License Number State | WA |
| # 14 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LP0808X |
| Taxonomy | Psychiatric/Mental Health Nurse Practitioner |
| License Number | NP95023143 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
