MEDICARE: MINA MARKLEY CASTLEMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1518578954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINA MARKLEY CASTLEMAN

Provider Business Mailing Address
First Line	:	3864 35TH ST APT 12
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3162
Country	:	US
Telephone Number	:	512-705-2284
Fax Number	:

Provider Business Practice Location Address
First Line	:	3864 35TH ST APT 12
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3162
Country	:	US
Telephone Number	:	512-705-2284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	08/10/2020

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Directions to “ MINA MARKLEY CASTLEMAN ” Practice Location

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