Provider Demographics
NPI:1073905105
Name:JOSE GABRIEL CASTELLANOS, MD, INC.
Entity type:Organization
Organization Name:JOSE GABRIEL CASTELLANOS, MD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTELLANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-859-3297
Mailing Address - Street 1:234 E BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2115
Mailing Address - Country:US
Mailing Address - Phone:626-915-9992
Mailing Address - Fax:626-915-6108
Practice Address - Street 1:228 E BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2115
Practice Address - Country:US
Practice Address - Phone:626-732-9232
Practice Address - Fax:626-410-1121
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSE GABRIEL CASTELLANOS, MD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-26
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62398261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care