Provider Demographics
NPI:1427071356
Name:KASTELLO, JENNIFER CHRISTINE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:KASTELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:752 MEDICAL CENTER CT
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6658
Mailing Address - Country:US
Mailing Address - Phone:619-482-8406
Mailing Address - Fax:
Practice Address - Street 1:752 MEDICAL CENTER CT
Practice Address - Street 2:SUITE 106
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6658
Practice Address - Country:US
Practice Address - Phone:619-482-8406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15472363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health