Healthcare Provider Details

I. General information

NPI: 1659524924
Provider Name (Legal Business Name): MARK ANTHONY CASTRO CABRERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 02/04/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 5TH AVE
SPOKANE WA
99202-1334
US

IV. Provider business mailing address

PO BOX 3649
SPOKANE WA
99220-3649
US

V. Phone/Fax

Practice location:
  • Phone: 509-838-2531
  • Fax: 509-755-6580
Mailing address:
  • Phone: 509-838-2531
  • Fax: 509-755-6580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2012-00279
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD60545167
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: