Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 22979 | CA |
NPI | 1114083151 |
---|---|
Provider Name | Mrs. Martha Castro |
First Address | Temecula, CA 92590-2535 |
Second Address | Temecula, CA 92590-2535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 03/09/2021 |