1023440187 NPI number — SAN JUANITA BARBOSA CASTELLANO FNP

Table of content: SAN JUANITA BARBOSA CASTELLANO FNP (NPI 1023440187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023440187 NPI number — SAN JUANITA BARBOSA CASTELLANO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTELLANO
Provider First Name:
SAN JUANITA
Provider Middle Name:
BARBOSA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CIBRIAN
Provider Other First Name:
SAN JUANITA
Provider Other Middle Name:
BARBOSA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023440187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3942 E ELOWIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISALIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93292-4111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-799-3911
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5400 W. HILLSDALE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISALIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-738-7500
Provider Business Practice Location Address Fax Number:
559-627-0106
Provider Enumeration Date:
07/31/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  23339 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)