Provider Demographics
NPI:1558857755
Name:CASTELLANO, ANDREW M
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:CASTELLANO
Suffix:
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 1:2069 CALLE SOMBRA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5435
Mailing Address - Country:US
Mailing Address - Phone:505-920-3537
Mailing Address - Fax:
Practice Address - Street 1:2069 CALLE SOMBRA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5435
Practice Address - Country:US
Practice Address - Phone:505-920-3537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3736225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist