Provider Demographics
NPI:1598232357
Name:CASTRO, VANESSA GUADALUPE (CM60809994)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:GUADALUPE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:CM60809994
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 S NACHES AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2947
Mailing Address - Country:US
Mailing Address - Phone:509-248-1800
Mailing Address - Fax:509-576-3076
Practice Address - Street 1:102 S NACHES AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2947
Practice Address - Country:US
Practice Address - Phone:509-248-1800
Practice Address - Fax:509-576-3076
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2470A2800XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health InformationAssistant Record Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA91-0755984Medicaid