Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003074899 |
---|---|
Provider Name | Mr. Charles Alfonzo Castor-Thomas VIII |
First Address | San Jose, CA 95128-2608 |
Second Address | San Jose, CA 95128-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 28/05/2008 |