Provider Demographics
NPI:1376737593
Name:DE CASTRO, MA SOFIA B (PT)
Entity Type:Individual
Prefix:
First Name:MA SOFIA
Middle Name:B
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1230 E WASHINGTON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6450
Mailing Address - Country:US
Mailing Address - Phone:909-825-6716
Mailing Address - Fax:909-825-4339
Practice Address - Street 1:301 S FAIR OAKS AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2561
Practice Address - Country:US
Practice Address - Phone:626-744-0411
Practice Address - Fax:626-744-0431
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT 33747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist