Healthcare Provider Details

I. General information

NPI: 1992226062
Provider Name (Legal Business Name): JUDITH MORENO-CASTRO LMP/LMT, CST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NE 138TH AVE. #60
VANCOUVER WA
98684
US

IV. Provider business mailing address

2501 NE 138TH AVE #60
VANCOUVER WA
98684
US

V. Phone/Fax

Practice location:
  • Phone: 360-824-1099
  • Fax:
Mailing address:
  • Phone: 360-824-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberLMT-023358
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60763158
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: