Provider Demographics
NPI:1033976758
Name:MCCASTER, MATHEW ALLEN ((CTH))
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:ALLEN
Last Name:MCCASTER
Suffix:
Gender:M
Credentials:(CTH)
Other - Prefix:
Other - First Name:CHIEF
Other - Middle Name:
Other - Last Name:MATHIAS EL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4305 SUN DEVILS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313
Mailing Address - Country:US
Mailing Address - Phone:818-477-7244
Mailing Address - Fax:
Practice Address - Street 1:4305 SUN DEVILS AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-5441
Practice Address - Country:US
Practice Address - Phone:818-477-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACTH-202400222363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner