Healthcare Provider Details

I. General information

NPI: 1639802580
Provider Name (Legal Business Name): LETICIA CASTILLO ROCHA MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3652 MICHELSON DR RM 200
IRVINE CA
92612-1727
US

IV. Provider business mailing address

227 W CANADA APT 3
SAN CLEMENTE CA
92672-5687
US

V. Phone/Fax

Practice location:
  • Phone: 936-662-9423
  • Fax:
Mailing address:
  • Phone: 858-900-6175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12738
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: