Healthcare Provider Details

I. General information

NPI: 1669567301
Provider Name (Legal Business Name): CALVINE GARCIA CASTRO L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43015 BLACK DEER LOOP STE 103
TEMECULA CA
92590-3567
US

IV. Provider business mailing address

PO BOX 1534
WILDOMAR CA
92595-1534
US

V. Phone/Fax

Practice location:
  • Phone: 951-249-6236
  • Fax: 951-246-9964
Mailing address:
  • Phone: 951-249-6236
  • Fax: 951-246-9964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: