Healthcare Provider Details

I. General information

NPI: 1083528905
Provider Name (Legal Business Name): JASMINE MARIE CASTELLI CPSW, CCSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 E 20TH ST
FARMINGTON NM
87401-2151
US

IV. Provider business mailing address

16B ROAD 6255
KIRTLAND NM
87417-9039
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-0293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2083
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: