Mireille C Castan, PSY.D.
Individual provider Active NPI Clinical Psychologist · Patton, CA
NPI 1710087770 · NPPES record last updated Nov 7, 2014
Key facts
- NPI
- 1710087770
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY 20951 (CA)
- Practice address
- 3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369 - Phone
- (909) 425-7679
- Fax
- (909) 425-6635
- NPI assigned
- Sep 22, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gregor Medical Corporation
Practice addresses (Care Compare)
9377 Haven Ave
Suite 100
Rancho Cucamonga, CA 91730-5340
Phone (909) 906-1505
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080515000480 | CA | Practitioner - Clinical Psychologist | 1456420587 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 20951 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Department of State Hospitals | Current |
Accepting new patients | |
| Gregor Medical Corporation | Current |
Accepting new patients | |
| Department of State Hospitals | Current |
Accepting new patients | |
| Department of State Hospitals | Current | Accepting new patients |
Locations
3102 E Highland Ave
Ofc
Patton, CA 92369
Phone (909) 425-7000
3102 E Highland Ave
Patton, CA 92369
Phone (909) 425-7000
8300 Utica Ave
Ste 310
Rancho Cucamonga, CA 91730
Phone (909) 906-1505
9377 Haven Ave
Ste 100
Rancho Cucamonga, CA 91730
Phone (909) 906-1505
1215 O St
#3
Sacramento, CA 95814
Phone (916) 651-2805
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 20951 | CA | Yes |
Addresses
Primary practice location
3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Mailing address
3102 E. Highland Avenue
Medical Staff Office
Patton, CA 92369
Phone (909) 425-7679
Other providers in Patton, CA
- Cintia Clementina Caldera Cuevas
- Robin Campbell
- Elba I Campos
- Lorna Carlin
- Edward P Case
- Wendy Chan
- Carise Elizabeth Charles
- Elsie Cheng
- Rosemary Santos Chequer
- Johnnie CHI
All providers in Patton, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 7, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.