Healthcare Provider Details

I. General information

NPI: 1689281248
Provider Name (Legal Business Name): DANIELA CASTRO MOSQUEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 11/20/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 BERCUT DR STE C
SACRAMENTO CA
95811-0110
US

IV. Provider business mailing address

3780 ROSIN CT STE 110
SACRAMENTO CA
95834-1698
US

V. Phone/Fax

Practice location:
  • Phone: 916-363-1552
  • Fax: 916-363-1638
Mailing address:
  • Phone: 916-234-2577
  • Fax: 916-236-2577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: