Healthcare Provider Details

I. General information

NPI: 1407213788
Provider Name (Legal Business Name): ELIZABETH CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 LUCRETIA AVE
SAN JOSE CA
95122-3730
US

IV. Provider business mailing address

2731 JUNCTION AVE UNIT 640526
SAN JOSE CA
95164-4022
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-4789
  • Fax:
Mailing address:
  • Phone: 408-510-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: