MEDICARE: EDITH CASTRO DIAZ

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	106H00000X	Marriage & Family Therapist	158596	CA

General Provider Information

NPI Number	:	1710853148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDITH CASTRO DIAZ

Provider Business Mailing Address
First Line	:	2739 PEACH ST
Second Line	:
City	:	LIVE OAK
State	:	CA
Zip	:	95953-2274
Country	:	US
Telephone Number	:	530-788-6371
Fax Number	:

Provider Business Practice Location Address
First Line	:	2739 PEACH ST
Second Line	:
City	:	LIVE OAK
State	:	CA
Zip	:	95953-2274
Country	:	US
Telephone Number	:	530-788-6371
Fax Number	:

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

Provider Enumeration Date	:	10/14/2025
Last Update Date	:	10/14/2025

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Directions to “ EDITH CASTRO DIAZ ” Practice Location

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