Provider Demographics
NPI:1881475382
Name:WILSON, CALEB (RD)
Entity type:Individual
Prefix:MR
First Name:CALEB
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 N 1ST AVE APT 210
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5657
Mailing Address - Country:US
Mailing Address - Phone:602-531-5741
Mailing Address - Fax:
Practice Address - Street 1:7490 S CAMINO DE OESTE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-9308
Practice Address - Country:US
Practice Address - Phone:520-879-6137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered