Provider Demographics
NPI:1619277563
Name:VANEGAS CASTRO, KARLA P (HIS)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:P
Last Name:VANEGAS CASTRO
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23822 VALENCIA BLVD
Mailing Address - Street 2:STE # 103
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5302
Mailing Address - Country:US
Mailing Address - Phone:661-253-3277
Mailing Address - Fax:661-288-1490
Practice Address - Street 1:23822 VALENCIA BLVD
Practice Address - Street 2:STE # 103
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5302
Practice Address - Country:US
Practice Address - Phone:661-253-3277
Practice Address - Fax:661-288-1490
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7107247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other