Provider Demographics
NPI:1568089613
Name:CASTOR, KINDRA NICOLE
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:NICOLE
Last Name:CASTOR
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 1:5 HARRIS CT STE 201
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5750
Mailing Address - Country:US
Mailing Address - Phone:831-375-4105
Mailing Address - Fax:831-642-4097
Practice Address - Street 1:5 HARRIS CT STE 201
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5750
Practice Address - Country:US
Practice Address - Phone:831-375-4105
Practice Address - Fax:831-642-4097
Is Sole Proprietor?:No
Enumeration Date:2020-07-05
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1972542959207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program