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General NPI Number Information
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NPI Number | 1205634813
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Entity Type | Individual
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Provider Name | MIRIAM NATALY CASTILLEJOS
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Gender | Female
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 3223 PRIMROSE AVE
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City | SANTA ROSA
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State | CA
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Zip | 95407-7723
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Country | US
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Telephone | 707-542-5195
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Fax |
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Provider Business Mailing Address
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Address Line | 1512 GARY CT
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City | ROHNERT PARK
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State | CA
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Zip | 94928-4819
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Country | US
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Telephone | 707-236-7123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 220146514
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License Number State | CA
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