Healthcare Provider Details

I. General information

NPI: 1457810442
Provider Name (Legal Business Name): IMILCE VICTORIA CASTRO PAZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20642 JOHN DR
CASTRO VALLEY CA
94546-5103
US

IV. Provider business mailing address

20642 JOHN DR
CASTRO VALLEY CA
94546-5103
US

V. Phone/Fax

Practice location:
  • Phone: 510-581-2559
  • Fax:
Mailing address:
  • Phone: 510-581-2559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA181220
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA181220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: