MEDICARE: CARLA MARCELA CASTRO LVN

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	164X00000X	Licensed Vocational Nurse	VN722465	CA

General Provider Information

NPI Number	:	1548902778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA MARCELA CASTRO LVN

Provider Business Mailing Address
First Line	:	4901 GREEN RIVER RD SPC 310
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92878-5622
Country	:	US
Telephone Number	:	714-420-4036
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 GREEN RIVER RD SPC 310
Second Line	:
City	:	CORONA
State	:	CA
Zip	:	92878-5622
Country	:	US
Telephone Number	:	714-420-4036
Fax Number	:

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

Provider Enumeration Date	:	04/08/2022
Last Update Date	:	04/08/2022

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