MEDICARE: DR. MONETA B DE CASTRO MD

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	208000000X	Pediatrics Physician	H5865	TX

General Provider Information

NPI Number	:	1487699898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONETA B DE CASTRO MD

Provider Business Mailing Address
First Line	:	4445 OAK PARK LANE
Second Line	:	#201
City	:	FT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-922-0798
Fax Number	:	817-922-0976

Provider Business Practice Location Address
First Line	:	4445 OAK PARK LANE
Second Line	:	#201
City	:	FT WORTH
State	:	TX
Zip	:	76109
Country	:	US
Telephone Number	:	817-922-0798
Fax Number	:	817-922-0976

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/08/2007

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