| Organization Name: | JOSE MARIANO CASTRO D D S INC |
| NPI Number: | 1043679061 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSE MARIANO CASTRO (OWNER) |
| Mailing Address: | 9113 Foothill Blvd Ste 210 Rancho Cucamonga |
| State: | CA US |
| Postal Code: | 917303452 |
| Phone Number: | 9094661245 |
| Fax Number: | |
| NPI Enumeration Date: | 02/18/2016 |
| NPI Last Update Date: | 02/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 43911 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |