Individual provider Active NPI

Carlos Anthony Castro, MSW

  • Psychiatric/Mental Health Nurse Practitioner
  • San Bernardino, CA
National Provider Identifier
1205976941
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95022963 Issued in CA
Practice address
742 W Highland Ave
San Bernardino, CA 92405-3839
Phone
(909) 881-7320
Fax
(909) 881-7330
NPI assigned
Feb 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN95235553 CA
Clinical Social Worker 1041C0700X 79451 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95022963 CA Primary

Addresses

Primary practice location

742 W Highland Ave
San Bernardino, CA 92405-3839

Mailing address

742 W Highland Ave
San Bernardino, CA 92405-3839
Phone (909) 881-7320

Other practice location 1

303 E Vanderbilt Way
San Bernardino, CA 92415-5230
Phone (909) 386-8239

Other practice location 2

1501 Hughes Way Ste 150
Long Beach, CA 90810-1878
Phone (310) 221-6336

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251006003708 CA Practitioner - Nurse Practitioner 1850898081 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

11147 Tamarisk Rd
Adelanto, CA 92301-3623

742 W Highland Ave
San Bernardino, CA 92405-3839

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
79451CAMDClinical Social Worker
RN95235553CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
San Marcos Medical Group Inc CurrentSince Jun 20, 2025 Accepting new patients

Locations

7965 Sierra Ave
Ste E
Fontana, CA 92336
Phone (909) 356-4459

14980 Summit Ave
Ste 230
Fontana, CA 92336
Phone (909) 803-1160

742 W Highland Ave
Sn Bernrdno, CA 92405
Phone (909) 881-7320

Interoperability endpoints

  • Direct secure messaging: carlos.castro.p1@direct.metro.nextgenshare.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727654400000",
    "number": "1205976941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "742 W HIGHLAND AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924053839",
            "telephone_number": "909-881-7320",
            "fax_number": "909-881-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 W HIGHLAND AVE",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924053839",
            "telephone_number": "909-881-7320",
            "fax_number": "909-881-7330"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 E Vanderbilt Way",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "924155230",
            "country_code": "US",
            "telephone_number": "909-386-8239",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 Hughes Way Ste 150",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908101878",
            "country_code": "US",
            "telephone_number": "310-221-6336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASTRO",
        "first_name": "CARLOS",
        "middle_name": "ANTHONY",
        "credential": "MSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "RN95235553",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "79451",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95022963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.