MEDICARE: CHRISTINE GONZALES CASTRO DMD

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	122300000X	Dentist	43132	CA
2	122300000X	Dentist	43121	CA

General Provider Information

NPI Number	:	1235149204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE GONZALES CASTRO DMD

Provider Business Mailing Address
First Line	:	120 BIRMINGHAM DRIVE
Second Line	:	SUITE 130
City	:	CARDIFF BY THE SEA
State	:	CA
Zip	:	92007-1744
Country	:	US
Telephone Number	:	760-944-1041
Fax Number	:	760-944-1074

Provider Business Practice Location Address
First Line	:	120 BIRMINGHAM DRIVE
Second Line	:	SUITE 130
City	:	CARDIFF BY THE SEA
State	:	CA
Zip	:	92007-1744
Country	:	US
Telephone Number	:	760-944-1041
Fax Number	:	760-944-1074

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	09/25/2014

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