Provider Demographics
NPI:1366805665
Name:CASTRO, GARRETT HERLINDO (DIVE IDC)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:HERLINDO
Last Name:CASTRO
Suffix:
Gender:M
Credentials:DIVE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 TARAWA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-5198
Mailing Address - Country:US
Mailing Address - Phone:619-473-5393
Mailing Address - Fax:
Practice Address - Street 1:2930 TARAWA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5198
Practice Address - Country:US
Practice Address - Phone:619-473-5393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman