Provider Demographics
NPI:1013714187
Name:CASTRO DELLER, EMILCE (MSW)
Entity type:Individual
Prefix:
First Name:EMILCE
Middle Name:
Last Name:CASTRO DELLER
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3754 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-6071
Mailing Address - Country:US
Mailing Address - Phone:707-835-6055
Mailing Address - Fax:707-829-3797
Practice Address - Street 1:3754 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-6071
Practice Address - Country:US
Practice Address - Phone:707-835-6055
Practice Address - Fax:707-829-3797
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA496801600310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility