Provider Demographics
NPI:1336847193
Name:DE CASTRO, MEGAN MENSALVAS (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:MENSALVAS
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ROQUE
Other - Last Name:MENSALVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:4995 CORTE SANTICO
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6960
Mailing Address - Country:US
Mailing Address - Phone:760-805-2114
Mailing Address - Fax:
Practice Address - Street 1:4995 CORTE SANTICO
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-6960
Practice Address - Country:US
Practice Address - Phone:760-805-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22008372A235Z00000X
CA32033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA32033OtherCALIFORNIA SPEECH PATHOLOGIST LICENSE