Provider Demographics
NPI:1316708597
Name:DECASTRO, JONALYN HERCE (IOM AND CNIM)
Entity type:Individual
Prefix:
First Name:JONALYN
Middle Name:HERCE
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:IOM AND CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 103631
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91189-3631
Mailing Address - Country:US
Mailing Address - Phone:213-378-2373
Mailing Address - Fax:213-785-8864
Practice Address - Street 1:3863 SHERWOOD PL
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-4607
Practice Address - Country:US
Practice Address - Phone:213-784-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty