Provider Demographics
NPI:1801435979
Name:CASTRO, YESENIA (BS HEALTH SCIENCE)
Entity type:Individual
Prefix:
First Name:YESENIA
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:BS HEALTH SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 WOOLDRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250-1028
Mailing Address - Country:US
Mailing Address - Phone:909-496-5542
Mailing Address - Fax:
Practice Address - Street 1:1603 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2212
Practice Address - Country:US
Practice Address - Phone:760-679-0540
Practice Address - Fax:760-679-0541
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician