Provider Demographics
NPI:1114749785
Name:CASTEN, LUISITO JR
Entity type:Individual
Prefix:
First Name:LUISITO
Middle Name:
Last Name:CASTEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ZION DR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8737
Mailing Address - Country:US
Mailing Address - Phone:310-975-5634
Mailing Address - Fax:
Practice Address - Street 1:22356 VALDIVIA
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-1413
Practice Address - Country:US
Practice Address - Phone:310-975-5634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility