Provider Demographics
NPI:1659193589
Name:CASTRO, KYARA DOMINIK
Entity type:Individual
Prefix:
First Name:KYARA
Middle Name:DOMINIK
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 1:634 YUCCA ST
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-8924
Mailing Address - Country:US
Mailing Address - Phone:760-897-6937
Mailing Address - Fax:
Practice Address - Street 1:634 YUCCA ST
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-8924
Practice Address - Country:US
Practice Address - Phone:760-897-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst