Provider Demographics
NPI:1750652012
Name:CASTRO, ALICIA LEIGH (CMT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:LEIGH
Last Name:CASTRO
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W LEXINGTON AVE
Mailing Address - Street 2:#202
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6207
Mailing Address - Country:US
Mailing Address - Phone:559-623-4677
Mailing Address - Fax:
Practice Address - Street 1:6225 N FRESNO ST
Practice Address - Street 2:SUITET 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5268
Practice Address - Country:US
Practice Address - Phone:559-623-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19857171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor