Healthcare Provider Details

I. General information

NPI: 1245033380
Provider Name (Legal Business Name): JAMIE VERZOSA CASTRO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E 3RD ST STE 702
LOS ANGELES CA
90013-1647
US

IV. Provider business mailing address

2436 MEDLOW AVE
LOS ANGELES CA
90041-2923
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-0561
  • Fax:
Mailing address:
  • Phone: 323-382-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: