Provider Demographics
NPI:1669567301
Name:CASTRO, CALVINE GARCIA (LAC)
Entity type:Individual
Prefix:MR
First Name:CALVINE
Middle Name:GARCIA
Last Name:CASTRO
Suffix:
Gender:M
Credentials:LAC
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Mailing Address - Street 1:PO BOX 1534
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-1534
Mailing Address - Country:US
Mailing Address - Phone:951-249-6236
Mailing Address - Fax:951-246-9964
Practice Address - Street 1:43015 BLACK DEER LOOP STE 103
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3567
Practice Address - Country:US
Practice Address - Phone:951-249-6236
Practice Address - Fax:951-246-9964
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC9012171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist