Provider Demographics
NPI:1336737089
Name:CASTRO, KIMBERLY (LVN)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11935 SIERRA RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2142
Mailing Address - Country:US
Mailing Address - Phone:951-848-2160
Mailing Address - Fax:
Practice Address - Street 1:11935 SIERRA RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2142
Practice Address - Country:US
Practice Address - Phone:951-848-2160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706023164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty