Provider Demographics
NPI:1760977508
Name:CASTRO, RICARDO PARAGAS JR
Entity Type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:PARAGAS
Last Name:CASTRO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 E BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-2220
Mailing Address - Country:US
Mailing Address - Phone:775-225-7213
Mailing Address - Fax:
Practice Address - Street 1:639 K ST
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-3739
Practice Address - Country:US
Practice Address - Phone:775-358-2204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005041510Medicaid