MEDICARE: SIDAVANN MONICA DECASTRO OTR

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	225X00000X	Occupational Therapist		CA

General Provider Information

NPI Number	:	1912403825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDAVANN MONICA DECASTRO OTR

Provider Business Mailing Address
First Line	:	8975 BALBOA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1507
Country	:	US
Telephone Number	:	858-653-6085
Fax Number	:

Provider Business Practice Location Address
First Line	:	8975 BALBOA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1507
Country	:	US
Telephone Number	:	858-653-6085
Fax Number	:

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

Provider Enumeration Date	:	04/01/2018
Last Update Date	:	02/03/2026

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