Provider Demographics
NPI:1366832123
Name:CASTRO, ROSARIO
Entity Type:Individual
Prefix:MRS
First Name:ROSARIO
Middle Name:
Last Name:CASTRO
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 1:6559 MAMMOTH CANYON PL
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-1227
Mailing Address - Country:US
Mailing Address - Phone:702-355-9563
Mailing Address - Fax:
Practice Address - Street 1:6559 MAMMOTH CANYON PL
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-1227
Practice Address - Country:US
Practice Address - Phone:702-355-9563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141158407374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide