Provider Demographics
NPI:1801944863
Name:CASTELLANOS, LUISA PASTORA (PHD PSYCHOLOGIST, CO)
Entity type:Individual
Prefix:DR
First Name:LUISA
Middle Name:PASTORA
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:PHD PSYCHOLOGIST, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13914
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013-3914
Mailing Address - Country:US
Mailing Address - Phone:505-523-4036
Mailing Address - Fax:505-523-4038
Practice Address - Street 1:3831 E LOHMAN AVE # 2
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8266
Practice Address - Country:US
Practice Address - Phone:505-523-4036
Practice Address - Fax:505-523-4038
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1297103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM003M73OtherBLUE CROSS BLUE SHIELD
NM53784740Medicaid
NM86998OtherPRESBYTERIAN
NMNMW2144OtherVALUE OPTIONS OF NM
NM300521088Medicare PIN