Healthcare Provider Details

I. General information

NPI: 1124737499
Provider Name (Legal Business Name): VALERIA C CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2022
Last Update Date: 11/16/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 STEELHEAD RD
FAIRBANKS AK
99709-3035
US

IV. Provider business mailing address

70 STEELHEAD RD
FAIRBANKS AK
99709-3035
US

V. Phone/Fax

Practice location:
  • Phone: 907-750-6785
  • Fax:
Mailing address:
  • Phone: 907-750-6785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number101292
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: