Provider Demographics
NPI:1093029423
Name:DE CASTRO, MARLENE MALAGUIT (RN)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:MALAGUIT
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 E HUNTINGTON DR
Mailing Address - Street 2:UNIT 4
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3224
Mailing Address - Country:US
Mailing Address - Phone:626-446-5468
Mailing Address - Fax:626-446-7068
Practice Address - Street 1:159 E HUNTINGTON DR
Practice Address - Street 2:UNIT 4
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3224
Practice Address - Country:US
Practice Address - Phone:626-446-5468
Practice Address - Fax:626-446-7068
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457539163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-9163Medicaid
CA05-9163Medicaid