Healthcare Provider Details

I. General information

NPI: 1891074589
Provider Name (Legal Business Name): VALERIE SUZANNE CASTRO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TULLY RD STE A-2
MODESTO CA
95350-2946
US

IV. Provider business mailing address

1800 TULLY RD STE A-2
MODESTO CA
95350-2946
US

V. Phone/Fax

Practice location:
  • Phone: 209-622-1420
  • Fax: 209-491-0627
Mailing address:
  • Phone: 209-622-1420
  • Fax: 209-491-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: