Provider Demographics
NPI:1336861665
Name:TUIASOSOPO, CALEB
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:
Last Name:TUIASOSOPO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MORNING DOVE TRL
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-1935
Mailing Address - Country:US
Mailing Address - Phone:254-444-7391
Mailing Address - Fax:
Practice Address - Street 1:1201 MORNING DOVE TRL
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-1935
Practice Address - Country:US
Practice Address - Phone:254-444-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program