Healthcare Provider Details

I. General information

NPI: 1710383179
Provider Name (Legal Business Name): KRISTEN BOWERMAN CASTRO ALICEA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

100 MADISON AVE
MORRISTOWN NJ
07960-6136
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-2880
  • Fax:
Mailing address:
  • Phone: 973-971-7926
  • Fax: 973-290-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD175700
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: