MEDICARE: MS. ELIZABETH ANGELA CAETANO PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist	PSY12286	CA

General Provider Information

NPI Number	:	1851451173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH ANGELA CAETANO PHD

Provider Business Mailing Address
First Line	:	1761 BROADWAY ST STE 100
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94589-2227
Country	:	US
Telephone Number	:	707-645-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1761 BROADWAY ST STE 100
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94589-2227
Country	:	US
Telephone Number	:	707-645-2700
Fax Number	:	707-645-2181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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