Provider Demographics
NPI:1629194949
Name:CASTRO, MARITZA GLORIA (BA)
Entity Type:Individual
Prefix:MS
First Name:MARITZA
Middle Name:GLORIA
Last Name:CASTRO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:MARITZA
Other - Middle Name:GLORIA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BA
Mailing Address - Street 1:1251 S GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3204
Mailing Address - Country:US
Mailing Address - Phone:818-549-2250
Mailing Address - Fax:
Practice Address - Street 1:1251 S GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-3204
Practice Address - Country:US
Practice Address - Phone:818-549-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner