Healthcare Provider Details

I. General information

NPI: 1265788426
Provider Name (Legal Business Name): SAM A CASTRO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W SHAW AVE #7
FRESNO CA
93704-2657
US

IV. Provider business mailing address

333 W SHAW AVE #7
FRESNO CA
93704-2657
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-6864
  • Fax: 559-221-8917
Mailing address:
  • Phone: 559-221-6864
  • Fax: 559-221-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberCO15434
License Number StateCA

VIII. Authorized Official

Name: DR. SAM A CASTRO
Title or Position: OWNER
Credential: M.D.
Phone: 559-221-6864