Healthcare Provider Details

I. General information

NPI: 1770364176
Provider Name (Legal Business Name): NATHALIE CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATHALIE PINEDA

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14434 AMBAUM BLVD SW STE 5
BURIEN WA
98166-1438
US

IV. Provider business mailing address

8025 45TH AVE SW
SEATTLE WA
98136-2220
US

V. Phone/Fax

Practice location:
  • Phone: 206-812-6171
  • Fax:
Mailing address:
  • Phone: 786-303-7452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: