Healthcare Provider Details

I. General information

NPI: 1164253720
Provider Name (Legal Business Name): ADRIAN CASTRO MEDINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ARGENTINA 501 B
MEXICALI BAJA CALIFORNIA
21230
MX

IV. Provider business mailing address

1101 OLLIE AVE UNIT 1606
CALEXICO CA
92232-7066
US

V. Phone/Fax

Practice location:
  • Phone: 686-349-2497
  • Fax:
Mailing address:
  • Phone: 686-349-2497
  • Fax: 619-329-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ADRIAN CASTRO MEDINA
Title or Position: PROVIDER
Credential: DDS
Phone: 686-349-2497