Basic Information
| Provider Information | |||||||||
| NPI: | 1477040822 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CASTRO | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15650 N BLACK CANYON HWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850534068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028660550 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15650 N BLACK CANYON HWY | ||||||||
| Address2: | STE 100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6028660550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2018 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 66746 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.