Provider Demographics
NPI:1699540229
Name:CASTRO, REBECCA JENNIFER
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JENNIFER
Last Name:CASTRO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MARGIE CT
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-5234
Mailing Address - Country:US
Mailing Address - Phone:909-295-4222
Mailing Address - Fax:
Practice Address - Street 1:405 MARGIE CT
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-5234
Practice Address - Country:US
Practice Address - Phone:909-295-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC55271164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse