Provider Demographics
NPI:1649631607
Name:CASTRO, JESUS (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JESUS
Other - Middle Name:
Other - Last Name:CASTRO-SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1604 DEER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-5035
Mailing Address - Country:US
Mailing Address - Phone:706-951-4838
Mailing Address - Fax:
Practice Address - Street 1:551 NATIONAL HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1495
Practice Address - Country:US
Practice Address - Phone:386-366-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist