Provider Demographics
NPI:1649506429
Name:CASTRO, JUAN A SR (CDC)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:A
Last Name:CASTRO
Suffix:SR
Gender:M
Credentials:CDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25431 AVENIDA ESCALERA
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2801
Mailing Address - Country:US
Mailing Address - Phone:818-641-2175
Mailing Address - Fax:661-505-7068
Practice Address - Street 1:25431 AVENIDA ESCALERA
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2801
Practice Address - Country:US
Practice Address - Phone:818-641-2175
Practice Address - Fax:661-505-7068
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9504101YA0400X
347C00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No347C00000XTransportation ServicesPrivate Vehicle
No101Y00000XBehavioral Health & Social Service ProvidersCounselor