Provider Demographics
NPI:1619228863
Name:CASTRO, CYNTHIA KRYSTAL
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KRYSTAL
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:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:WINTON
Mailing Address - State:CA
Mailing Address - Zip Code:95388-0709
Mailing Address - Country:US
Mailing Address - Phone:209-478-9862
Mailing Address - Fax:
Practice Address - Street 1:555 W BENJAMIN HOLT DR
Practice Address - Street 2:SUITE 400
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3839
Practice Address - Country:US
Practice Address - Phone:209-478-9862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator