Provider Demographics
NPI:1033670559
Name:CASTRO, DANIEL RAMIREZ
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RAMIREZ
Last Name:CASTRO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82896 LONGFELLOW CT
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-9327
Mailing Address - Country:US
Mailing Address - Phone:760-679-6603
Mailing Address - Fax:
Practice Address - Street 1:82896 LONGFELLOW CT
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-9327
Practice Address - Country:US
Practice Address - Phone:760-679-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB-1003663172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver