Provider Demographics
NPI:1225604317
Name:CASTRO FLORES, OFELIA
Entity Type:Individual
Prefix:
First Name:OFELIA
Middle Name:
Last Name:CASTRO FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16408 N 24TH PL UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2998
Mailing Address - Country:US
Mailing Address - Phone:480-925-9922
Mailing Address - Fax:
Practice Address - Street 1:4716 E THUNDERBIRD RD STE 154
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5541
Practice Address - Country:US
Practice Address - Phone:480-925-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-21244225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty