Provider Demographics
NPI:1831242692
Name:CASTRO, ANTONIO DAVID (MED-ECN)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:DAVID
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MED-ECN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 E HACIENDA DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-2909
Mailing Address - Country:US
Mailing Address - Phone:928-344-1947
Mailing Address - Fax:
Practice Address - Street 1:400 W 5TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2945
Practice Address - Country:US
Practice Address - Phone:928-502-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZYSD18928OtherAZ FOUNDATION FOR MEDICAL