Provider Demographics
NPI:1528572849
Name:ROBERTS, CALEB WILLIAM FREEMAN (DACM, LAC)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:WILLIAM FREEMAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3166 GRAPE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-1215
Mailing Address - Country:US
Mailing Address - Phone:760-793-3385
Mailing Address - Fax:
Practice Address - Street 1:7851 MISSION CENTER CT STE 255
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:760-793-3385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17896171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist