Healthcare Provider Details

I. General information

NPI: 1548874191
Provider Name (Legal Business Name): KATHERINE CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 S VILLAGE OAKS DR
COVINA CA
91724-3617
US

IV. Provider business mailing address

631 HELENSBURG ST
GLENDORA CA
91740-4724
US

V. Phone/Fax

Practice location:
  • Phone: 310-374-3300
  • Fax: 310-374-3307
Mailing address:
  • Phone: 925-787-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: