MEDICARE: JESSICA CASTEEL LVN

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	164X00000X	Licensed Vocational Nurse	264199	CA

General Provider Information

NPI Number	:	1669805149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA CASTEEL LVN

Provider Business Mailing Address
First Line	:	2100 1ST AVE APT 21
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-2066
Country	:	US
Telephone Number	:	858-395-6209
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 CLAIREMONT DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2706
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

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

Provider Enumeration Date	:	08/19/2013
Last Update Date	:	08/19/2013

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