Provider Demographics
NPI:1083716385
Name:CASTRO, MIGUEL ANGEL (MIGUEL CASTRO)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MIGUEL CASTRO
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:ANGEL
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MIGUEL ANGEL CASTRO
Mailing Address - Street 1:4153 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2047
Mailing Address - Country:US
Mailing Address - Phone:760-427-0839
Mailing Address - Fax:
Practice Address - Street 1:3180 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-2045
Practice Address - Country:US
Practice Address - Phone:760-427-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19741103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist