Healthcare Provider Details

I. General information

NPI: 1942894035
Provider Name (Legal Business Name): KATRINA CASTELLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 ESTATES DR STE E
ROSEVILLE CA
95678-2353
US

IV. Provider business mailing address

401 VERNON ST STE B
ROSEVILLE CA
95678-2600
US

V. Phone/Fax

Practice location:
  • Phone: 408-706-6855
  • Fax:
Mailing address:
  • Phone: 916-581-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: