Provider Demographics
NPI:1386196012
Name:CASTELLO, MARISSA (ND)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:CASTELLO
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 TRESCONY ST APT A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4737
Mailing Address - Country:US
Mailing Address - Phone:206-387-8840
Mailing Address - Fax:
Practice Address - Street 1:736 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3761
Practice Address - Country:US
Practice Address - Phone:831-477-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND844175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath