MEDICARE: KRISTA M 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1992080337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA M CASTRO

Provider Business Mailing Address
First Line	:	1466 LORILYN AVE
Second Line	:	UNIT 3
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6394
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9850 S MARYLAND PKWY
Second Line	:	SUITE A5-286
City	:	LAS VEGAS
State	:	NV
Zip	:	89183-7146
Country	:	US
Telephone Number	:	702-807-5364
Fax Number	:

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

Provider Enumeration Date	:	10/17/2011
Last Update Date	:	10/17/2011

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Directions to “ KRISTA M CASTRO ” Practice Location

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