1295592863 NPI number — ANA CRISTINA CASTRO

Table of content: ANA CRISTINA CASTRO (NPI 1295592863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295592863 NPI number — ANA CRISTINA CASTRO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTRO
Provider First Name:
ANA
Provider Middle Name:
CRISTINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295592863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
710 E SAN YSIDRO BLVD STE 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN YSIDRO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92173-3123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-831-0437
Provider Business Mailing Address Fax Number:
619-785-3404

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1856 E AJAIME ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN LUIS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85336-0440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-831-0437
Provider Business Practice Location Address Fax Number:
619-785-3404
Provider Enumeration Date:
02/29/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12184000 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)