Healthcare Provider Details

I. General information

NPI: 1295909356
Provider Name (Legal Business Name): DOLORES R CASTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 FIRST PARK TEN BLVD
SAN ANTONIO TX
78213-4308
US

IV. Provider business mailing address

10506 PALMDALE ST
SAN ANTONIO TX
78230-2417
US

V. Phone/Fax

Practice location:
  • Phone: 210-733-0524
  • Fax:
Mailing address:
  • Phone: 210-275-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number17260
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: