Provider Demographics
NPI:1467281014
Name:CASTRO, CELIA J
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:J
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 1:133 S RIDGEWAY DR # 1032
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4611
Mailing Address - Country:US
Mailing Address - Phone:817-907-0298
Mailing Address - Fax:
Practice Address - Street 1:103 S OLD BETSY RD STE B
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:TX
Practice Address - Zip Code:76059-2471
Practice Address - Country:US
Practice Address - Phone:817-704-8061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1798172V00000X
TX2024070006171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes172V00000XOther Service ProvidersCommunity Health Worker