Provider Demographics
NPI:1972178739
Name:CASTILLO MUNOZ, KENIA JAZMIN
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:JAZMIN
Last Name:CASTILLO MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KENIA
Other - Middle Name:JAZMIN
Other - Last Name:GONZALEZ MUNOZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13801 WESTBORO DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-3135
Mailing Address - Country:US
Mailing Address - Phone:408-691-1189
Mailing Address - Fax:
Practice Address - Street 1:1171 HOMESTEAD RD STE 250
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-5485
Practice Address - Country:US
Practice Address - Phone:408-320-2590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician