Provider Demographics
NPI:1255493979
Name:CASTRO, CARMENCITA GARCIA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:CARMENCITA
Middle Name:GARCIA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:120 NEPTUNE PL
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2076
Mailing Address - Country:US
Mailing Address - Phone:760-420-7596
Mailing Address - Fax:760-739-1949
Practice Address - Street 1:750 E GRAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4460
Practice Address - Country:US
Practice Address - Phone:760-738-7008
Practice Address - Fax:760-738-1459
Is Sole Proprietor?:No
Enumeration Date:2006-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6841171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0068410OtherMEDICAL PROVIDER NO.