Provider Demographics
NPI:1851153969
Name:CASTER, EMERY JAMES (DTCM LAC)
Entity Type:Individual
Prefix:
First Name:EMERY
Middle Name:JAMES
Last Name:CASTER
Suffix:
Gender:M
Credentials:DTCM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2008
Mailing Address - Country:US
Mailing Address - Phone:760-835-3670
Mailing Address - Fax:
Practice Address - Street 1:3654 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2008
Practice Address - Country:US
Practice Address - Phone:760-835-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-24
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19893171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist