MEDICARE: NAYELI 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	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst		CA

General Provider Information

NPI Number	:	1053922591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAYELI CASTRO

Provider Business Mailing Address
First Line	:	24081 SANDY GLADE AVE
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-5529
Country	:	US
Telephone Number	:	951-525-1990
Fax Number	:

Provider Business Practice Location Address
First Line	:	9518 56TH ST
Second Line	:
City	:	JURUPA VALLEY
State	:	CA
Zip	:	92509-4832
Country	:	US
Telephone Number	:	951-519-8783
Fax Number	:

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

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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Directions to “ NAYELI CASTRO ” Practice Location

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