Provider Demographics
NPI:1215816467
Name:CASTILLO, MARCELLA ELAINE
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:ELAINE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1224 COLOMA WAY STE 190
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4601
Mailing Address - Country:US
Mailing Address - Phone:408-560-6652
Mailing Address - Fax:408-510-6850
Practice Address - Street 1:1224 COLOMA WAY STE 190
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4601
Practice Address - Country:US
Practice Address - Phone:408-560-6652
Practice Address - Fax:408-510-6850
Is Sole Proprietor?:No
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker