MEDICARE: GIA DESIREE CASTRO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1023771938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GIA DESIREE CASTRO

Provider Business Mailing Address
First Line	:	1527 E CESAR CHAVEZ AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033
Country	:	US
Telephone Number	:	562-252-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1527 E. CESAR CHAVEZ AVE.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033
Country	:	US
Telephone Number	:	562-252-1400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2021
Last Update Date	:	10/18/2021

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Directions to “ GIA DESIREE CASTRO ” Practice Location

Language	Start Address	Practice Location

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