Healthcare Provider Details

I. General information

NPI: 1710559174
Provider Name (Legal Business Name): CHRISTIE CASTELLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2021
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MORRIS RD
EDGEWOOD NM
87015-6757
US

IV. Provider business mailing address

18 MORRIS RD
EDGEWOOD NM
87015-6757
US

V. Phone/Fax

Practice location:
  • Phone: 980-257-2622
  • Fax:
Mailing address:
  • Phone: 980-257-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: