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General NPI Number Information
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NPI Number | 1649631607
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Entity Type | Individual
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Provider Name | JESUS CASTRO PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 551 NATIONAL HEALTH CARE DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1495
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Country | US
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Telephone | 386-366-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 1604 DEER SPRINGS RD
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City | PORT ORANGE
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State | FL
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Zip | 32129-5035
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Country | US
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Telephone | 706-951-4838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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