Provider Demographics
NPI:1073342531
Name:CASTRO, JANINE
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NYSSA
Mailing Address - State:OR
Mailing Address - Zip Code:97913-3815
Mailing Address - Country:US
Mailing Address - Phone:541-372-5738
Mailing Address - Fax:
Practice Address - Street 1:17 S 3RD ST
Practice Address - Street 2:
Practice Address - City:NYSSA
Practice Address - State:OR
Practice Address - Zip Code:97913-3815
Practice Address - Country:US
Practice Address - Phone:541-372-5738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker