Provider Demographics
NPI:1457600462
Name:CASTILLO, MICHELLE ESPINOZA (MA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ESPINOZA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4344 DRIVING RANGE RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-0688
Mailing Address - Country:US
Mailing Address - Phone:949-257-2104
Mailing Address - Fax:
Practice Address - Street 1:300 SPECTRUM CENTER DR STE 400
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4989
Practice Address - Country:US
Practice Address - Phone:949-572-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist