Provider Demographics
NPI:1164253720
Name:ADRIAN CASTRO MEDINA
Entity type:Organization
Organization Name:ADRIAN CASTRO MEDINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTRO MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:686-349-2497
Mailing Address - Street 1:1101 OLLIE AVE UNIT 1606
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92232-7066
Mailing Address - Country:US
Mailing Address - Phone:686-349-2497
Mailing Address - Fax:619-329-9663
Practice Address - Street 1:ARGENTINA 501 B
Practice Address - Street 2:
Practice Address - City:MEXICALI
Practice Address - State:BAJA CALIFORNIA
Practice Address - Zip Code:21230
Practice Address - Country:MX
Practice Address - Phone:686-349-2497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty