MEDICARE: DR. M.H. CHARLENE CASTRO DDS

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	45096	CA

General Provider Information

NPI Number	:	1861557332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. M.H. CHARLENE CASTRO DDS

Provider Business Mailing Address
First Line	:	11336 SOUTH ST
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-5414
Country	:	US
Telephone Number	:	562-924-4588
Fax Number	:	562-924-4599

Provider Business Practice Location Address
First Line	:	11336 SOUTH ST
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-5414
Country	:	US
Telephone Number	:	562-924-4588
Fax Number	:	562-924-4599

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/08/2007

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