Healthcare Provider Details

I. General information

NPI: 1154283919
Provider Name (Legal Business Name): FABRIENNE CASTRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7533 S CENTER VIEW CT # 5150
WEST JORDAN UT
84084-5526
US

IV. Provider business mailing address

826 W 450 N
OREM UT
84057-3602
US

V. Phone/Fax

Practice location:
  • Phone: 801-214-8070
  • Fax:
Mailing address:
  • Phone: 385-375-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9077668-3503
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: