Provider Demographics
NPI:1851410088
Name:CASTELLARI, VIOLET BERNADETTE
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:BERNADETTE
Last Name:CASTELLARI
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 1:1212 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-5436
Mailing Address - Country:US
Mailing Address - Phone:858-922-4270
Mailing Address - Fax:619-523-8742
Practice Address - Street 1:3340 KEMPER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4906
Practice Address - Country:US
Practice Address - Phone:619-523-8121
Practice Address - Fax:619-523-8742
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA373781Medicaid