Provider Demographics
NPI:1235712860
Name:CASTRO, IRENE (PA-C)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
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 1:2680 YAKIMA VALLEY HWY STE B
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-1242
Mailing Address - Country:US
Mailing Address - Phone:509-839-3000
Mailing Address - Fax:509-839-1013
Practice Address - Street 1:2680 YAKIMA VALLEY HWY STE B
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-1242
Practice Address - Country:US
Practice Address - Phone:509-839-3000
Practice Address - Fax:509-839-1013
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61163611363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty