Provider Demographics
NPI:1831824747
Name:CASTRO, CHRISTINA NICOLE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:NICOLE
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 1:3807 EL MORENO ST
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1606
Mailing Address - Country:US
Mailing Address - Phone:818-823-7140
Mailing Address - Fax:
Practice Address - Street 1:3807 EL MORENO ST
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1606
Practice Address - Country:US
Practice Address - Phone:818-823-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-24
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist