Provider Demographics
NPI:1942018080
Name:CASTRO, JESSICA JANEL
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JANEL
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:JANEL
Other - Last Name:LICHVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1019 CRYSTAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-8744
Mailing Address - Country:US
Mailing Address - Phone:402-917-6163
Mailing Address - Fax:
Practice Address - Street 1:1019 CRYSTAL SPRINGS DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-8744
Practice Address - Country:US
Practice Address - Phone:402-917-6163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023633363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner