Provider Demographics
NPI:1194766113
Name:CASTELLI, MARIA VIRGINIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:VIRGINIA
Last Name:CASTELLI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2542 S BASCOM AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-5541
Mailing Address - Country:US
Mailing Address - Phone:408-559-3403
Mailing Address - Fax:408-559-3158
Practice Address - Street 1:2542 S BASCOM AVE
Practice Address - Street 2:STE 110
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-5541
Practice Address - Country:US
Practice Address - Phone:408-559-3403
Practice Address - Fax:408-559-3158
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN291997163W00000X
CANP12655363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNP12655BMedicare PIN
CAW416Medicare PIN
S44281Medicare UPIN