Healthcare Provider Details

I. General information

NPI: 1710819917
Provider Name (Legal Business Name): TAYLOR MARIE CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 FAIRMONT DR
SAN LEANDRO CA
94578-1001
US

IV. Provider business mailing address

2050 FAIRMONT DR
SAN LEANDRO CA
94578-1001
US

V. Phone/Fax

Practice location:
  • Phone: 510-483-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number733972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: