Provider Demographics
NPI:1457608440
Name:CASTRO, KORY M (HAS)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:M
Last Name:CASTRO
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10869 N SCOTTSDALE RD STE 103-147
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5280
Mailing Address - Country:US
Mailing Address - Phone:541-490-4416
Mailing Address - Fax:
Practice Address - Street 1:10893 N SCOTTSDALE RD STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5279
Practice Address - Country:US
Practice Address - Phone:480-534-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-10131231237700000X
AZHADR6449237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist