Provider Demographics
NPI:1528379690
Name:DISTOR-CASTRO, MONINA (RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MONINA
Middle Name:
Last Name:DISTOR-CASTRO
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:MONINA
Other - Middle Name:DISTOR
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, FNP-BC
Mailing Address - Street 1:5750 DOWNEY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-1411
Mailing Address - Country:US
Mailing Address - Phone:562-630-3105
Mailing Address - Fax:562-633-4600
Practice Address - Street 1:12200 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2804
Practice Address - Country:US
Practice Address - Phone:562-622-4106
Practice Address - Fax:562-622-4222
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily