Provider Demographics
NPI:1881468072
Name:CASTELLANOS, KENYA (LM, CPM)
Entity type:Individual
Prefix:MS
First Name:KENYA
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1593 CASA REAL LN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2217
Mailing Address - Country:US
Mailing Address - Phone:760-703-5213
Mailing Address - Fax:
Practice Address - Street 1:1593 CASA REAL LN
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2217
Practice Address - Country:US
Practice Address - Phone:760-703-5213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM713176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife