Provider Demographics
NPI:1487699898
Name:DE CASTRO, MONETA B (MD)
Entity type:Individual
Prefix:DR
First Name:MONETA
Middle Name:B
Last Name:DE CASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARLA MONETA
Other - Middle Name:BENITO
Other - Last Name:DE CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4445 OAK PARK LANE
Mailing Address - Street 2:#201
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109
Mailing Address - Country:US
Mailing Address - Phone:817-922-0798
Mailing Address - Fax:817-922-0976
Practice Address - Street 1:4445 OAK PARK LANE
Practice Address - Street 2:#201
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-922-0798
Practice Address - Fax:817-922-0976
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5865208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F21155Medicare UPIN