Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand | 14580 | CA |
NPI | 1285852814 |
---|---|
Provider Name | Ms. Ilene Sharon Castro |
First Address | Mission Viejo, CA 92691-4935 |
Second Address | Irvine, CA 92614-6234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 08/07/2007 |