Provider Demographics
NPI:1962538884
Name:CASTRO, FATIMA MILAGROS (BA)
Entity type:Individual
Prefix:MISS
First Name:FATIMA
Middle Name:MILAGROS
Last Name:CASTRO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11105 ROSE AVE
Mailing Address - Street 2:APT. 105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6057
Mailing Address - Country:US
Mailing Address - Phone:310-500-7887
Mailing Address - Fax:
Practice Address - Street 1:1085 VICTORIA STREET
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-5804
Practice Address - Country:US
Practice Address - Phone:310-868-5379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7493AOtherSTARVIEW