Provider Demographics
NPI:1306656830
Name:CASTRO GONZALEZ, MARIANA DEL CARMEN (SA-C)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:DEL CARMEN
Last Name:CASTRO GONZALEZ
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 STONEY POINT CIR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-7992
Mailing Address - Country:US
Mailing Address - Phone:346-433-7886
Mailing Address - Fax:
Practice Address - Street 1:661 STONEY POINT CIR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-7992
Practice Address - Country:US
Practice Address - Phone:346-433-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-545246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant