Provider Demographics
NPI:1528535432
Name:CASTRO, VANDRIC JON
Entity Type:Individual
Prefix:
First Name:VANDRIC
Middle Name:JON
Last Name:CASTRO
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 1:5025 COLLWOOD BLVD # 3221
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-2126
Mailing Address - Country:US
Mailing Address - Phone:971-284-7912
Mailing Address - Fax:
Practice Address - Street 1:11650 IBERIA PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2406
Practice Address - Country:US
Practice Address - Phone:909-689-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-29
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician