Healthcare Provider Details

I. General information

NPI: 1871324012
Provider Name (Legal Business Name): ISELA GASTELUM CASTRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AV LAZARO 544 STE 9
TECATE BAJA CALIFORNIA
21400
MX

IV. Provider business mailing address

433A TECATE RD 148
TECATE CA
91980
US

V. Phone/Fax

Practice location:
  • Phone: 665-799-2077
  • Fax: 619-329-9663
Mailing address:
  • Phone: 665-799-2077
  • Fax: 619-329-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ISELA GASTELUM CASTRO
Title or Position: PROVIDER
Credential: DDS
Phone: 619-272-9021