Healthcare Provider Details

I. General information

NPI: 1346954849
Provider Name (Legal Business Name): MS. KAYLEE CASTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 RIVERVIEW DR
JURUPA VALLEY CA
92509-6611
US

IV. Provider business mailing address

111 W HARRISON ST UNIT 323
CORONA CA
92878-3406
US

V. Phone/Fax

Practice location:
  • Phone: 951-360-4175
  • Fax:
Mailing address:
  • Phone: 626-655-5820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number135671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: