Provider Demographics
NPI:1174130165
Name:CASTRO, JOANN C (BASW / CHW)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:C
Last Name:CASTRO
Suffix:
Gender:F
Credentials:BASW / CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 CHOLAME RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-2480
Mailing Address - Country:US
Mailing Address - Phone:760-243-5417
Mailing Address - Fax:
Practice Address - Street 1:15863 DESERT CANDLE LN
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1483
Practice Address - Country:US
Practice Address - Phone:760-953-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174130165Medicaid
CA1518207885Medicaid