Healthcare Provider Details

I. General information

NPI: 1053244350
Provider Name (Legal Business Name): JUAN MANUEL CASTRO M.A., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22365 BARTON RD STE 104
GRAND TERRACE CA
92313-5037
US

IV. Provider business mailing address

10791 VERNA LN
LOMA LINDA CA
92354-6100
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-2899
  • Fax:
Mailing address:
  • Phone: 909-492-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number39553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: