Provider Demographics
NPI:1467038620
Name:CASTREJON, BRIANA YVETTE
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:YVETTE
Last Name:CASTREJON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 SIERRA ST
Mailing Address - Street 2:
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-2534
Mailing Address - Country:US
Mailing Address - Phone:209-614-9271
Mailing Address - Fax:
Practice Address - Street 1:3920 SIERRA ST
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-2534
Practice Address - Country:US
Practice Address - Phone:209-614-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician