Provider Demographics
NPI:1851833107
Name:CASTRO, HAZEL TABAO (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:TABAO
Last Name:CASTRO
Suffix:
Gender:F
Credentials:APRN-C
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Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3910 S MARYLAND PKWY STE 9B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7570
Mailing Address - Country:US
Mailing Address - Phone:702-982-7240
Mailing Address - Fax:702-586-7506
Practice Address - Street 1:3910 S MARYLAND PKWY STE 9B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7570
Practice Address - Country:US
Practice Address - Phone:702-982-7240
Practice Address - Fax:702-586-7506
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVAPRN002638363L00000X
IL209014354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1851833107Medicaid