Healthcare Provider Details

I. General information

NPI: 1245999465
Provider Name (Legal Business Name): KAREN LUCILLE CASTRO H.I.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23822 VALENCIA BLVD STE 103
VALENCIA CA
91355-5303
US

IV. Provider business mailing address

3901 E 53RD ST
MAYWOOD CA
90270-2217
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-3277
  • Fax:
Mailing address:
  • Phone: 323-514-5024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA8709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: