Provider Demographics
NPI:1407290513
Name:CASTELAZO, MYRNA AYDE (MD)
Entity type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:AYDE
Last Name:CASTELAZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MYRNA
Other - Middle Name:
Other - Last Name:CASTELAZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:798 S WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2928
Mailing Address - Country:US
Mailing Address - Phone:408-984-7226
Mailing Address - Fax:
Practice Address - Street 1:798 S WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2928
Practice Address - Country:US
Practice Address - Phone:408-984-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1339132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology