Healthcare Provider Details

I. General information

NPI: 1730433707
Provider Name (Legal Business Name): MARITESS CASTILLO MORALES MSN, RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 PENNSYLVANIA AVE SUITE C
FAIRFIELD CA
94533-3551
US

IV. Provider business mailing address

1620 PENNSYLVANIA AVE SUITE C
FAIRFIELD CA
94533-3551
US

V. Phone/Fax

Practice location:
  • Phone: 707-428-4878
  • Fax:
Mailing address:
  • Phone: 707-428-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number748784
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: