Healthcare Provider Details

I. General information

NPI: 1093639817
Provider Name (Legal Business Name): CAROLINA CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 AVENIDA DE LA CRUZ
SAN YSIDRO CA
92173-2114
US

IV. Provider business mailing address

1875 AVENIDA DE LA CRUZ
SAN YSIDRO CA
92173-2114
US

V. Phone/Fax

Practice location:
  • Phone: 619-992-7752
  • Fax:
Mailing address:
  • Phone: 619-992-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberB20250427031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: