Basic Information
| Provider Information | |||||||||
| NPI: | 1306957139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTRO | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | |||||||||
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| Credential: | FSP | ||||||||
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| OtherLastName: | CASTRO | ||||||||
| OtherFirstName: | SARA | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9445 FARNHAM ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8583804676 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1840 WILSON AVE STE C | ||||||||
| Address2: | |||||||||
| City: | NATIONAL CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919505515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194770242 | ||||||||
| FaxNumber: | 6194770799 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.