Healthcare Provider Details

I. General information

NPI: 1295352631
Provider Name (Legal Business Name): DESIREE CHRISTINE MARTINEZ DEL CASTILLO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 05/06/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4148 TOWN CENTER BLVD.
MADERA CA
93636
US

IV. Provider business mailing address

106 POLLASKY AVE
CLOVIS CA
93612-1159
US

V. Phone/Fax

Practice location:
  • Phone: 559-664-4000
  • Fax: 559-675-5224
Mailing address:
  • Phone: 559-203-3775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number117105
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: