Individual
JEANNA MAE CASTRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3609 4TH AVE, SAN DIEGO, CA 92103-4105
(619) 255-0789
Mailing address
3609 4TH AVE, SAN DIEGO, CA 92103-4105
(619) 255-0789
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
472887029
CA
Other
Enumeration date
06/11/2016
Last updated
06/11/2016
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