Provider Demographics
NPI:1851901888
Name:CASTELLANOS, BLANCA F
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:F
Last Name:CASTELLANOS
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 1:1802 NORTH IMPERIAL AVE D 130
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9545
Mailing Address - Country:US
Mailing Address - Phone:760-707-4175
Mailing Address - Fax:
Practice Address - Street 1:1413 W STATE ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2834
Practice Address - Country:US
Practice Address - Phone:760-565-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-04
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-42442103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst