Provider Demographics
NPI:1770823437
Name:CASTRO, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
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 1:415 BEAR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PIPE CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:78063-5856
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3463 MAGIC DR
Practice Address - Street 2:SUITE T21
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2973
Practice Address - Country:US
Practice Address - Phone:210-614-8101
Practice Address - Fax:210-614-8102
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-18
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13-538246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant