Provider Demographics
NPI:1477684504
Name:CASTOR, JOAQUIN VALDIVIA
Entity Type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:VALDIVIA
Last Name:CASTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8829 S FIR AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-1810
Mailing Address - Country:US
Mailing Address - Phone:323-646-6122
Mailing Address - Fax:
Practice Address - Street 1:8829 S FIR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-1810
Practice Address - Country:US
Practice Address - Phone:323-646-6122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker