Provider Demographics
NPI:1649062191
Name:CASTRO-VALENZUELA, ESDRAS
Entity type:Individual
Prefix:
First Name:ESDRAS
Middle Name:
Last Name:CASTRO-VALENZUELA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 LANTERN LN
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-2509
Mailing Address - Country:US
Mailing Address - Phone:574-326-5548
Mailing Address - Fax:
Practice Address - Street 1:1016 LANTERN LN
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-2509
Practice Address - Country:US
Practice Address - Phone:574-326-5548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20130694171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter