Healthcare Provider Details

I. General information

NPI: 1619277563
Provider Name (Legal Business Name): KARLA P VANEGAS CASTRO HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23822 VALENCIA BLVD STE # 103
VALENCIA CA
91355-5302
US

IV. Provider business mailing address

23822 VALENCIA BLVD STE # 103
VALENCIA CA
91355-5302
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-3277
  • Fax: 661-288-1490
Mailing address:
  • Phone: 661-253-3277
  • Fax: 661-288-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberHA7107
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: