Provider Demographics
NPI:1043030042
Name:CASTER, ELIZABETH NJENGA
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NJENGA
Last Name:CASTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 WHITNEY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6537
Mailing Address - Country:US
Mailing Address - Phone:707-761-3466
Mailing Address - Fax:
Practice Address - Street 1:2820 WHITNEY DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6537
Practice Address - Country:US
Practice Address - Phone:707-761-3466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24001202343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)