Provider Demographics
NPI:1891528212
Name:MIGUEL A CASTRO, PSY.D., PSYCHOLOGIST, INC.
Entity type:Organization
Organization Name:MIGUEL A CASTRO, PSY.D., PSYCHOLOGIST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIGUEL
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:706-604-4885
Mailing Address - Street 1:1350 COLUMBIA ST UNIT 402
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3455
Mailing Address - Country:US
Mailing Address - Phone:760-604-4885
Mailing Address - Fax:888-315-5512
Practice Address - Street 1:1350 COLUMBIA ST UNIT 402
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3455
Practice Address - Country:US
Practice Address - Phone:760-604-4885
Practice Address - Fax:888-315-5512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty