Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003220542 |
---|---|
Provider Name | Maurisa Castillo |
First Address | Santa Ana, CA 92705-8529 |
Second Address | Santa Ana, CA 92705-8529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 12/06/2014 |