Healthcare Provider Details

I. General information

NPI: 1639033764
Provider Name (Legal Business Name): LESLIE CASTRO-LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW STE 206
WASHINGTON DC
20011-1141
US

IV. Provider business mailing address

6323 GEORGIA AVE NW STE 206
WASHINGTON DC
20011-1141
US

V. Phone/Fax

Practice location:
  • Phone: 202-234-6855
  • Fax: 202-234-4863
Mailing address:
  • Phone: 202-234-6855
  • Fax: 202-234-4863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: