Provider Demographics
NPI:1497297345
Name:CASTRO, IRAIS
Entity Type:Individual
Prefix:
First Name:IRAIS
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 1:4065 MEDFORD CT
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6713
Mailing Address - Country:US
Mailing Address - Phone:831-419-1882
Mailing Address - Fax:
Practice Address - Street 1:3260 BLUME DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5203
Practice Address - Country:US
Practice Address - Phone:510-262-6551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program