Basic Information
| Provider Information | |||||||||
| NPI: | 1619277563 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANEGAS CASTRO | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23822 VALENCIA BLVD | ||||||||
| Address2: | STE # 103 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612533277 | ||||||||
| FaxNumber: | 6612881490 | ||||||||
| Practice Location | |||||||||
| Address1: | 23822 VALENCIA BLVD | ||||||||
| Address2: | STE # 103 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913555302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612533277 | ||||||||
| FaxNumber: | 6612881490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2010 | ||||||||
| LastUpdateDate: | 10/26/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X | HA7107 | CA | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Other |
No ID Information.