Provider Demographics
NPI:1235335944
Name:CASTRO, JAN M (PA-C)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:M
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5495 S 500 E
Mailing Address - Street 2:STE 120
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6923
Mailing Address - Country:US
Mailing Address - Phone:801-479-0174
Mailing Address - Fax:801-479-8888
Practice Address - Street 1:5495 S 500 E
Practice Address - Street 2:STE 120
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6923
Practice Address - Country:US
Practice Address - Phone:801-479-0174
Practice Address - Fax:801-479-8888
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT198466-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical