Healthcare Provider Details

I. General information

NPI: 1235900986
Provider Name (Legal Business Name): TARA VEGA CASTRO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 ROUTE 168 STE 104
TURNERSVILLE NJ
08012-3224
US

IV. Provider business mailing address

860 ROUTE 168 STE 104
TURNERSVILLE NJ
08012-3224
US

V. Phone/Fax

Practice location:
  • Phone: 609-929-9343
  • Fax: 856-401-9551
Mailing address:
  • Phone: 609-929-9343
  • Fax: 856-401-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: TARA VEGA CASTRO
Title or Position: OWNER/ACUPUNCTURIST
Credential: L. AC
Phone: 609-929-9343