MEDICARE: ALEXSANDRIA RAQUEL 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	175T00000X	Peer Specialist	MPSS-AVDOMI	CA

General Provider Information

NPI Number	:	1467316794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXSANDRIA RAQUEL CASTRO

Provider Business Mailing Address
First Line	:	3737 N BLACKSTONE AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-5323
Country	:	US
Telephone Number	:	559-939-5299
Fax Number	:	559-939-5299

Provider Business Practice Location Address
First Line	:	2940 N FRESNO ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93703-1123
Country	:	US
Telephone Number	:	559-939-5999
Fax Number	:	559-939-5299

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

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	06/12/2026

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Directions to “ ALEXSANDRIA RAQUEL CASTRO ” Practice Location

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