# YOUR SPA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134668452
- **Authorized official:** MRS. ANTOINETT M CASTRO 32539 (LICENSED MASSAGE THERAPIST)
- **Authorized official phone:** (619) 255-0789

## Contact information

- **Practice address:** 3609 4TH AVE, SAN DIEGO, CA 92103-4105
- **Practice address phone:** (619) 255-0789
- **Mailing address:** 3609 4TH AVE, SAN DIEGO, CA 92103-4105
- **Mailing address phone:** (619) 255-0789

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | 32539 | CA | Yes |

## Other

- **Enumeration date:** 02/20/2017
- **Last updated:** 02/20/2017