Healthcare Provider Details

I. General information

NPI: 1699484352
Provider Name (Legal Business Name): ADRIANNA C CASTLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-8902
US

IV. Provider business mailing address

704 MOUNTAIN RANCH RD
SAN ANDREAS CA
95249-8902
US

V. Phone/Fax

Practice location:
  • Phone: 209-754-6525
  • Fax:
Mailing address:
  • Phone: 209-754-6525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: