Provider Demographics
NPI:1316518384
Name:CASTRO, TERESA DORAN (RDN, CNSC, CDCES)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:DORAN
Last Name:CASTRO
Suffix:
Gender:F
Credentials:RDN, CNSC, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 E 4TH ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3873
Mailing Address - Country:US
Mailing Address - Phone:714-228-3230
Mailing Address - Fax:
Practice Address - Street 1:2212 E 4TH ST STE 301
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3873
Practice Address - Country:US
Practice Address - Phone:714-288-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA727700133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered