Provider Demographics
NPI:1356171888
Name:FERRARIS-CASTRO, MARIA TINA CHUA (AMFT)
Entity type:Individual
Prefix:
First Name:MARIA TINA
Middle Name:CHUA
Last Name:FERRARIS-CASTRO
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1534
Mailing Address - Street 2:
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-1534
Mailing Address - Country:US
Mailing Address - Phone:951-249-6235
Mailing Address - Fax:
Practice Address - Street 1:41669 WINCHESTER RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4872
Practice Address - Country:US
Practice Address - Phone:951-319-2112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA146413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty