Healthcare Provider Details

I. General information

NPI: 1790344836
Provider Name (Legal Business Name): KERLLY PAOLA CASTELLANO CRESPO AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERLLY PAOLA CASTELLANO

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

1800 N LYNN ST APT 1615
ARLINGTON VA
22209-2025
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4000
  • Fax:
Mailing address:
  • Phone: 714-795-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA000114
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: