Healthcare Provider Details

I. General information

NPI: 1477369619
Provider Name (Legal Business Name): MIGUEL CASTELLANOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 S EASTERN AVE STE 156
COMMERCE CA
90040-4023
US

IV. Provider business mailing address

16380 ROSCOE BLVD STE 100
VAN NUYS CA
91406-1221
US

V. Phone/Fax

Practice location:
  • Phone: 833-227-3454
  • Fax:
Mailing address:
  • Phone: 833-227-3454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: