Healthcare Provider Details

I. General information

NPI: 1245733666
Provider Name (Legal Business Name): ROBERTO C CASTRO MARTINEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 STELLA LAKE ST STE 36
LAS VEGAS NV
89106-2144
US

IV. Provider business mailing address

6375 HAMILTON GROVE AVE
LAS VEGAS NV
89122-3640
US

V. Phone/Fax

Practice location:
  • Phone: 702-595-8309
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: