Basic Information
| Provider Information | |||||||||
| NPI: | 1780921627 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CEJA | ||||||||
| FirstName: | MARINA | ||||||||
| MiddleName: | CASTULA | ||||||||
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| Credential: | LMFT 107361 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 BROADWAY STE 1100 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958201527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168747711 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4600 BROADWAY STE 1100 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958201527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168749670 | ||||||||
| FaxNumber: | 9168756366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2013 | ||||||||
| LastUpdateDate: | 02/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 107361 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.