Healthcare Provider Details

I. General information

NPI: 1477988905
Provider Name (Legal Business Name): CASTINE MICHELLE ONEAL SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 W SUNSET BLVD STE 510
LOS ANGELES CA
90027-5864
US

IV. Provider business mailing address

12729 E RANCHO ESTATES PL
RANCHO CUCAMONGA CA
91739-2305
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-9380
  • Fax:
Mailing address:
  • Phone: 972-838-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: