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NPI Code Detail

MEDICARE: MRS. HEIDI CASTRO KELLY M.A.

MEDICARE: MRS. HEIDI CASTRO KELLY M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist46480CA

General Provider Information

NPI Number : 1720225584
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEIDI CASTRO KELLY M.A.
Provider Business Mailing Address
First Line : 751 E DAILY DR STE 310
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-6077
Country : US
Telephone Number : 805-231-6271
Fax Number :
Provider Business Practice Location Address
First Line : 751 E DAILY DR STE 320
Second Line :
City : CAMARILLO
State : CA
Zip : 93010-0772
Country : US
Telephone Number : 805-231-6271
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2009
Last Update Date : 06/28/2021

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