Healthcare Provider Details

I. General information

NPI: 1801944863
Provider Name (Legal Business Name): LUISA PASTORA CASTELLANOS PHD PSYCHOLOGIST, CO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3831 E LOHMAN AVE # 2
LAS CRUCES NM
88011-8266
US

IV. Provider business mailing address

PO BOX 13914
LAS CRUCES NM
88013-3914
US

V. Phone/Fax

Practice location:
  • Phone: 505-523-4036
  • Fax: 505-523-4038
Mailing address:
  • Phone: 505-523-4036
  • Fax: 505-523-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number1297
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1297
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: