Healthcare Provider Details

I. General information

NPI: 1568089613
Provider Name (Legal Business Name): KINDRA NICOLE CASTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2020
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HARRIS CT STE 201
MONTEREY CA
93940-5750
US

IV. Provider business mailing address

5 HARRIS CT STE 201
MONTEREY CA
93940-5750
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-4105
  • Fax: 831-642-4097
Mailing address:
  • Phone: 831-375-4105
  • Fax: 831-642-4097

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 State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number1972542959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: