Healthcare Provider Details

I. General information

NPI: 1871446344
Provider Name (Legal Business Name): JACKELINE CASTRO TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 DE MOSS ST
LORDSBURG NM
88045-2618
US

IV. Provider business mailing address

530 DE MOSS ST
LORDSBURG NM
88045-2618
US

V. Phone/Fax

Practice location:
  • Phone: 575-247-6036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDB-2026-0193
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: