MEDICARE: JESSICA INFANTE-CASTRO MA

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871969931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA INFANTE-CASTRO MA

Provider Business Mailing Address
First Line	:	100 WALLA WALLA AVE
Second Line	:
City	:	ELTOPIA
State	:	WA
Zip	:	99330-9611
Country	:	US
Telephone Number	:	509-845-6270
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 WALLA WALLA AVE
Second Line	:
City	:	ELTOPIA
State	:	WA
Zip	:	99330-9611
Country	:	US
Telephone Number	:	509-845-6270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2015
Last Update Date	:	12/27/2023

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