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General NPI Number Information
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NPI Number | 1306651591
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Entity Type | Individual
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Provider Name | JACQUELINE CASTELLON
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Gender | Female
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Dates
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Enumeration Date | 02/12/2025
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 6454 VAN NUYS BLVD STE 111
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City | VAN NUYS
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State | CA
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Zip | 91401-1445
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Country | US
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Telephone | 818-336-6411
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Fax |
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Provider Business Mailing Address
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Address Line | 295 E EDGEMONT DR
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-2210
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Country | US
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Telephone |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 94025782
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License Number State | CA
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