Healthcare Provider Details

I. General information

NPI: 1295402824
Provider Name (Legal Business Name): CRYSTAL CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2021
Last Update Date: 08/23/2021
Certification Date: 08/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PEACH DR
SALINAS CA
93901-3710
US

IV. Provider business mailing address

11 PEACH DR
SALINAS CA
93901-3710
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-6001
  • Fax: 831-753-5169
Mailing address:
  • Phone: 831-753-6001
  • Fax: 831-753-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberTBA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: