Provider Demographics
NPI:1679796569
Name:CASTRO, VIRGINIA MARTINEZ
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARTINEZ
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 1:1111 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1537
Mailing Address - Country:US
Mailing Address - Phone:209-468-2335
Mailing Address - Fax:209-468-0525
Practice Address - Street 1:1111 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1537
Practice Address - Country:US
Practice Address - Phone:209-468-2335
Practice Address - Fax:209-468-0525
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator