Provider Demographics
NPI:1023440187
Name:CASTELLANO, SAN JUANITA BARBOSA (FNP)
Entity type:Individual
Prefix:
First Name:SAN JUANITA
Middle Name:BARBOSA
Last Name:CASTELLANO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SAN JUANITA
Other - Middle Name:BARBOSA
Other - Last Name:CIBRIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3942 E ELOWIN AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-4111
Mailing Address - Country:US
Mailing Address - Phone:559-799-3911
Mailing Address - Fax:
Practice Address - Street 1:5400 W. HILLSDALE DRIVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291
Practice Address - Country:US
Practice Address - Phone:559-738-7500
Practice Address - Fax:559-627-0106
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23339363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA173672Medicare PIN