Healthcare Provider Details

I. General information

NPI: 1114083151
Provider Name (Legal Business Name): MARTHA CASTRO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/03/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27574 COMMERCE CENTER DR STE 131
TEMECULA CA
92590-2535
US

IV. Provider business mailing address

27574 COMMERCE CENTER DR STE 131
TEMECULA CA
92590-2535
US

V. Phone/Fax

Practice location:
  • Phone: 951-587-6932
  • Fax:
Mailing address:
  • Phone: 951-587-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number22979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: