Healthcare Provider Details

I. General information

NPI: 1699318832
Provider Name (Legal Business Name): NICOLLE CASTRO CAROCA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 P ST NW STE 200
WASHINGTON DC
20036-6924
US

IV. Provider business mailing address

2021 KALORAMA RD NW APT 6
WASHINGTON DC
20009-1464
US

V. Phone/Fax

Practice location:
  • Phone: 202-644-8904
  • Fax:
Mailing address:
  • Phone: 240-899-0717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG50082951
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: