MEDICARE: JAVIANNA VANESSA CASTELLANOS FERRER

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	41846	TX

General Provider Information

NPI Number	:	1912532771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIANNA VANESSA CASTELLANOS FERRER

Provider Business Mailing Address
First Line	:	40 BICKEL CT
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20165-5721
Country	:	US
Telephone Number	:	703-371-3473
Fax Number	:

Provider Business Practice Location Address
First Line	:	6560 FANNIN ST STE 1280
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-2753
Country	:	US
Telephone Number	:	713-441-5577
Fax Number	:

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

Provider Enumeration Date	:	03/11/2020
Last Update Date	:	04/08/2026

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