Provider Demographics
NPI:1881300499
Name:CASTOR, DAVID LLOYD
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LLOYD
Last Name:CASTOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10551 E BRECKINRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-5017
Mailing Address - Country:US
Mailing Address - Phone:520-551-9072
Mailing Address - Fax:
Practice Address - Street 1:2100 N WILMOT RD STE 201&202
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3021
Practice Address - Country:US
Practice Address - Phone:520-551-9072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ210732302255A2300X, 133VN1201X, 171400000X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No133VN1201XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Obesity and Weight Management
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral