Provider Demographics
NPI:1992226062
Name:MORENO-CASTRO, JUDITH (LMP/LMT, CST)
Entity type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:
Last Name:MORENO-CASTRO
Suffix:
Gender:F
Credentials:LMP/LMT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 NE 138TH AVE
Mailing Address - Street 2:#60
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:360-824-1099
Mailing Address - Fax:
Practice Address - Street 1:2501 NE 138TH AVE.
Practice Address - Street 2:#60
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-824-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172M00000X, 173C00000X
ORLMT-023358225700000X
WAMA60763158225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist