Healthcare Provider Details

I. General information

NPI: 1639030414
Provider Name (Legal Business Name): VANESSA CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N 1ST ST STE 135,154 & 163
FRESNO CA
93726-6800
US

IV. Provider business mailing address

3636 N 1ST ST STE 135&154
FRESNO CA
93726-6800
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-1464
  • Fax:
Mailing address:
  • Phone: 559-225-1464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: