Healthcare Provider Details

I. General information

NPI: 1720805971
Provider Name (Legal Business Name): NOELLE MICHELE CASTRO NESBITT ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 09/20/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 E ALGROVE ST
COVINA CA
91723-2707
US

IV. Provider business mailing address

4075 TWINING ST
JURUPA VALLEY CA
92509-6758
US

V. Phone/Fax

Practice location:
  • Phone: 818-723-9559
  • Fax:
Mailing address:
  • Phone: 951-990-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number99004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: