=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215407531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | G SALVADOR CASTILLO DENTAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2018
-----------------------------------------------------
Last Update Date | 11/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2446 NORDHOFF ST
-----------------------------------------------------
City | CHATSWORTH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-998-4884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2446 NORDHOFF ST
-----------------------------------------------------
City | CHATSWORTH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-998-4884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MISS MONICA MELLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 760-244-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------