Healthcare Provider Details

I. General information

NPI: 1932595022
Provider Name (Legal Business Name): TANYA MURIEL CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37945 30TH ST E APT 206
PALMDALE CA
93550-5533
US

IV. Provider business mailing address

37945 30TH ST E APT 206
PALMDALE CA
93550-5533
US

V. Phone/Fax

Practice location:
  • Phone: 661-874-3003
  • Fax:
Mailing address:
  • Phone: 661-874-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number67307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: