Healthcare Provider Details

I. General information

NPI: 1568282804
Provider Name (Legal Business Name): RAMIRO CASTELLON DE LA O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 LEXINGTON CT
MARINA CA
93933-4735
US

IV. Provider business mailing address

3016 LEXINGTON CT
MARINA CA
93933-4735
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-4522
  • Fax:
Mailing address:
  • Phone: 831-649-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: