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Contact Information

JENNIFER A CASTELLUCCIO, PAC
26458 MAPLE VALLEY BLACK DIAMOND RD SE
MAPLE VALLEY, WA98038
 Phone: 425-690-3460
 Fax: 425-690-9460
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
 

Medical

363AM0700X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for JENNIFER A CASTELLUCCIO · (Female)

NPI Number 1679561435
Status Active
Credentials PAC
Entity Individual
Enumeration date 10/06/2005
Last updated 08/17/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • WA License # OA10000132
  • WA Medicaid 1016090
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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