Provider Demographics
NPI:1720875016
Name:VALENTIN CASTA, ISMARIE LEAN
Entity type:Individual
Prefix:
First Name:ISMARIE
Middle Name:LEAN
Last Name:VALENTIN CASTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 COUNTRYBROOK LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-4496
Mailing Address - Country:US
Mailing Address - Phone:787-310-0233
Mailing Address - Fax:
Practice Address - Street 1:580 COUNTRYBROOK LOOP
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4496
Practice Address - Country:US
Practice Address - Phone:787-310-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician