Provider Demographics
NPI:1083370159
Name:CASTRO, RITA E (LICENSED NURSE)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:E
Last Name:CASTRO
Suffix:
Gender:F
Credentials:LICENSED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5617
Mailing Address - Country:US
Mailing Address - Phone:650-271-0411
Mailing Address - Fax:
Practice Address - Street 1:2351 LAWTON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5617
Practice Address - Country:US
Practice Address - Phone:650-271-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA182670164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse