Provider Demographics
NPI:1265788426
Name:SAM A CASTRO, M.D., INC.
Entity type:Organization
Organization Name:SAM A CASTRO, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-221-6864
Mailing Address - Street 1:333 W SHAW AVE
Mailing Address - Street 2:#7
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-2657
Mailing Address - Country:US
Mailing Address - Phone:559-221-6864
Mailing Address - Fax:559-221-8917
Practice Address - Street 1:333 W SHAW AVE
Practice Address - Street 2:#7
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2657
Practice Address - Country:US
Practice Address - Phone:559-221-6864
Practice Address - Fax:559-221-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACO154342084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty