Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G28757 | CA |
NPI | 1033186614 |
---|---|
Provider Name | Angela Castellano |
First Address | Sherman Oaks, CA 91403 |
Second Address | Sherman Oaks, CA 91403 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2006 |
Last Update Date | 20/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C353986 | (02) | |
C353986 | (02) | CA |