Provider Demographics
NPI:1932749579
Name:CASTRO, TASIA LYNNE (BA)
Entity Type:Individual
Prefix:
First Name:TASIA
Middle Name:LYNNE
Last Name:CASTRO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:TASIA
Other - Middle Name:LYNNE
Other - Last Name:WILKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9015 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3617
Mailing Address - Country:US
Mailing Address - Phone:408-842-7138
Mailing Address - Fax:408-842-0383
Practice Address - Street 1:9015 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3617
Practice Address - Country:US
Practice Address - Phone:408-842-7138
Practice Address - Fax:408-842-0383
Is Sole Proprietor?:No
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator