Healthcare Provider Details

I. General information

NPI: 1245874411
Provider Name (Legal Business Name): DIANA FLOR CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 GRAND AVE
SACRAMENTO CA
95838-3466
US

IV. Provider business mailing address

114 COPPER LEAF WAY
SACRAMENTO CA
95838-1852
US

V. Phone/Fax

Practice location:
  • Phone: 916-875-2182
  • Fax:
Mailing address:
  • Phone: 916-534-6204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-20985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: