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General NPI Number Information
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NPI Number | 1710383179
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Entity Type | Individual
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Provider Name | KRISTEN BOWERMAN CASTRO ALICEA MD
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Gender | Female
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 10180 SE SUNNYSIDE RD
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City | CLACKAMAS
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State | OR
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Zip | 97015-8970
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Country | US
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Telephone | 503-571-2880
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Fax |
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Provider Business Mailing Address
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Address Line | 100 MADISON AVE
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6136
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Country | US
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Telephone | 973-971-7926
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Fax | 973-290-7202
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD175700
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License Number State | OR
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